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MATERIA MEDICA FOR NURSES 



THE MACMILLAN COMPANY 

2?EW YORK • BOSTON • CHICAGO • DALLAS 
ATLANTA • SAN FRANCISCO 

MACMILLAN & CO., Limited 

LONDON . BOMBAY • CALCUTTA 
MELBOURNE 

THE MACMILLAN CO. OF CANADA, Lm 

TORONTO 



MATERIA MEDICA 

FOE NURSES 



A. S. BLUMGARTEN, M.D., F.A.C.P. 

ASSOCIATE ATTENDING PHYSICIAN TO THE LENOX HILL HOSPITAL; 
ATTENDING PHYSICIAN TO THE HOSPITAL FOR JOINT DIS- 
EASES; LECTURER TO THE TRAINING SCHOOL OF THE 
LENOX HILL HOSPITAL, NEW YORK; FELLOW OF 
THE NEW YORK ACADEMY OF MEDICINE. ETC 



THIRD EDITION 
Completely revised 



N^m fork 
THE MACMILLAN COMPANY 

1922 

All rights reserved 



PRINTED IX THE UNITED STATES OF AMERICA 






Copyright, 1914, 1916 axd 1920, 
By THE MACMILLAN COMPANY 



bfct up ana electrotyped. Published May, 1914 

Second Revised Edition, September, 1916 

Third Revised Edition, August, 1920 






FERRIS 

PRINTING COMPANY 

NEW YORK CITY 










TO MY FATHER 

WHOSE PATERNAL LOVE AND SYMPATHY HAVE 

BEEN A CONSTANT INSPIRATION TO 

THE AUTHOR 

THIS BOOK IS AFFECTIONATELY DEDICATED. 



*v 



PREFACE TO THIRD REVISED 
EDITION 



The experience of the World War has not only added many 
new substances to our therapeutic armamentarium, but it has 
changed our methods of using old remedies and developed new 
points of view. This rapid progress of both medicine and nursing 
and the desire to keep the book abreast of the times have created 
a demand for a new edition of this book whose previous editions 
and their numerous reprints were so cordially and gratefully re- 
ceived. 

The object of this edition is merely to add the changes dictated 
by the progress of the sciences directly or indirectly related to 
the use of drugs, and to include the new substances in common 
use. There is no departure from the original plan of the book, 
which is to teach the facts about drugs that are of practical value 
to the nurse, in an inductive manner. To accomplish this object 
we must utilize the facts that the nurse gains in her practical ex- 
perience, adding thereto those that cannot be obtained at the 
bedside, but always emphasizing the nurse's practical point of 
view. By combining the facts derived from both these sources 
we can develop clear practical concepts about the use of drugs. 

Owing to the World War numerous substances that were for- 
merly a foreign manufacture are now made in the United States 
under a different name; for example, Novocaine is also called 
Procaine, Veronal is Barbital, Salvarsan is now called Arsphena- 
mine, Diarsenol, etc. These substances are described in the text 
under both names. 

Perhaps our most important medical heritage of the World War 
is the Carrel Dakin method of treating wounds. Dakin's solution 
and its numerous preparations have therefore been described in 
detail. Optochin, Papaverine and Benzyl Benzoate, new sub- 
stances which are extensively used, have also been added. 

The chapter on Organic Remedies has been entirely rewritten 
and enlarged, to keep pace with the growing importance of these 
substances in modern therapeutics. In describing them I have 



viii PREFACE 

departed, however, from the method followed in the rest of the 
book, because the subject is still in its infancy and I have at- 
tempted to scrupulously adhere to the known facts about these 
substances. The text on sodium bicarbonate and magnesium 
sulphate has been enlarged to conform to the broader therapeutic 
use of these substances. 

I desire to express my sincere thanks to the many- friends in 
both nursing and medical professions for the helpful suggestions 
and the Idndly interest shown in the previous editions. Finally, 
I wish to express my appreciation to my publishers for their pains- 
taking efforts in bringing out this edition under very trying 
circumstances. 

A. S. Blumgarten. 



PREFACE TO SECOND REVISED 
EDITION 

The recent advances in Pharmacology, Physiology and 
allied subjects have created a demand for a new edition of 
this book, whose first edition, and its many reprints, was 
tendered such a cordial and gratifying reception. This 
made it necessary to reset the book, which has given 
me the opportunity to incorporate many additions and 
changes which are dictated by the progress of medicine and 
nursing, and by my further experience in the use of the in- 
ductive method in teaching nurses in a number of institu- 
tions of various types. In these I have found the inductive 
method to be singularly adapted to the development of tho 
essential skill in the nurse's highly important, yet purely 
passive function in the use of remedies. It was according 
to this method that the first edition of this book was written, 
with the aim of developing clear, interesting word pictures 
of the effects of drugs and of correlating the class study with 
the nurse's actual observation and practical work. 

Perhaps the branch of Materia Medica most important to 
the nurse is the Administration of Medicines; yet, ^^mirabile 
dictu," this is the most neglected branch. An attempt is 
made in the chapter on the ^^Administration of Medicines " 
to place this subject on a definite, scientific and practical 
basis. A large part of this subject-matter appeared in a 
series of articles in the ''American Journal of Nursing" during 
1914 and 1915. In offering this chapter I am cognizant of 
the fact that we are far from the millennium in our knowledge 
of Materia Medica and Pharmacology, or any other live 
natural science. Life and the philosophy of its phenomena 
are subject to constant change. Nevertheless, I have util- 
ized the known scientific facts as a basis for formulating 
rational and uniform methods of administration. 

The chapters on '^Solutions" and the 'Preparation of 
Doses " have been simplified and elaborated. The type prob- 

ix 



X PREFACE 

lems have been illustrated by means of numerous diagrams, 
a method which I have found to be very helpful in teaching 
solutions. A summary and numerous problems have been 
added to these chapters to overcome the frequent difficulty 
in obtaining a broad general survey of solutions after the 
methods for their calculation and preparation have been 
mastered. 

While the classification of the drugs follows the same 
general plan of Stimulants and Depressants, the drugs are 
more closely grouped around the organs they principally 
affect. 

The position of caffeine and alcohol in the classification has 
been changed to conform to the more recent pharmacological 
conceptions. The chapters on serums, vaccines and organic 
remedies have been grouped with the specifics to conform 
to the therapeutic classification. The relation of digitahs 
action to the newer ideas on the physiology of the heart 
has also been added. The same visual method has been 
followed under the action of the drugs, but additions and 
changes have been made for the sake of clearness wherever 
these seemed to be indicated. 

A few newer drugs have been added; no old drugs have 
been omitted; all the unimportant and infrequently used 
substances have been condensed. An appendix on ^'The 
Harrison Law" and its practical application to hospital 
nursing has also been added. 

I desire to express my sincere thanks to the many friends 
throughout the country, in both the nursing and medical pro- 
fessions, whose kindly interest in my small efforts has served 
as a gratifying stimulant. Finally, especial thanks are due 
Drs. Norbert Stadtmueller and Walter J. Heimann for 
helpful suggestions; to Miss Adele S. Poston and Miss 
Mildred Seigler for their kind assistance in the tedious work 
of proof reading; and to my publishers for the pains they 
have taken with the many technical details. 

A. S. Blumgarten. 



PREFACE 

The modern nurse is no longer merely the gentle attendant at 
the sick bed, able to perform only a few practical duties, but she is 
now also a watchful trained observer; of symptoms of disease, of the 
development of complications, and of the effects of drugs and their 
poisonous symptoms. In this capacity, and because of her con- 
stant presence at the bedside, she is of inestimable value to the 
physician in the management of the complex and often treacherous 
phenomena of disease. 

The object of this text book is to develop intelligent, trained ob- 
servers of the effects of drugs and to enable the nurse to administer 
medicines accurately. The majority of text books for nurses are 
entirely too technical, with the result that the nurse learns a great 
many technical terms without gaining a clear idea of the changes 
that drugs produce in the functions of the human body. An at- 
tempt is therefore made to present the subject in a strictly peda- 
gogic manner, to teach facts, not words, and always to proceed 
from the known to the unknown. The new matter presented is 
based throughout upon facts previously explained. The phar- 
macological action is arranged in a simple, concise manner to facili- 
tate the remembrance of the text. The numerous tables scattered 
throughout the book are intended to correlate the facts already 
learned; for example, a table of Cardiac Stimulants follows the 
discussion of the drugs in this group; a table of comparative actions 
follows that of the Atropine group, etc. 

It is also essential that, before taking up the changes which drugs 
produce in the action of the body, the nurse have some idea of the 
normal action of the body. For this reason there have been scat- 
tered through the text numerous notes on Normal Physiology wher- 
ever it was felt to be necessary to a clear understanding of the drugs 
presented, since the arrangement of the curriculum in most training 
schools is such that Physiology is often studied at a later time than 
Materia Medica. 

The nurse has ample opportunity, in the wards, to observe the 
effects of drugs on actual patients; but she does not benefit from 
this opportunity because her observation is untrained. It is to 

xi 



xii PREFACE 

assist and train her observation that the descriptions of the 
" Appearance of the Patient '' are inserted in the text. These 
enable the nurse to compare the effects of a particular drug, given 
to an individual patient, with the standard description of that 
drug as given in the text. 

Little attention is given to therapeutics; as the nurse should 
never treat, but administer and observe. It is occasionally im- 
portant, however, that in administering certain potent drugs she 
should have some idea of the reason for such administration, to 
aid her in the observation of their effects. Short notes on the use 
of some of the important drugs are therefore inserted. 

The chapter on ''Solutions" deals with this very important sub- 
ject at great length, because the proper and accurate administra- 
tion of drugs, and the preparation of accurate solutions, is of prime 
importance to the nurse. Most of the rules for the calculation of 
solutions given in the text are entirely original and have been 
found in actual practice to be the easiest and simplest. This chap- 
ter also contains many helpful tables, such as "Saturation Points," 
''Usual Strengths of Standard Solutions," etc. 

This book is perhaps larger than many texts on this subject but 
this is due to the inclusion in the text of the following features 
usually not dealt with: the chapter on "Solutions"; the chapter 
on "Prescription Reading," a subject required by most State 
Boards; and particularly by the inclusion, among the preparations, 
of most of the "New and Non-Official Remedies" in common use. 
Many of these substances are extensively used, and it is the nurse 
who has to administer them. Where is she to find the action and 
preparations of these drugs if not in her text book? 

The classification of the drugs is based upon their therapeutic 
use since the nurse learns their action in this way. They are ar- 
ranged in two distinct groups: "Stimulants" and "Depressants," 
and then according to the particular organs of the body they prin- 
cipally affect. 

I desire to express my sincere thanks to Dr. Richard Stein and 
Dr. Norbert Stadtmueller for their careful examination of the 
proofs; and to Miss Anna L. Schulze, R. N., former Superintend- 
ent, and Miss Elizabeth P. Lindheimer, R. N., the present Superin- 
tendent of the German Hospital Training School for Nurses, New 
York, for valuable suggestions. 

I avail myself of the opportunity to acknowledge the use, as 
references, of the following works: "Pharmacology and Thera- 
peutics," by A. R. Cushny; "Therapeutics, Its Principles and 



PREFACE xiii 

Practice," by H. C. Wood; '' Essentials of Materia Medica and 
Therapeutics/' by Henry Morris; ''New and Non-Official Rem- 
edies," 1913 edition, of the American Medical Association; and to 
notes on the Lectures on Pharmacology delivered by Dr. W. A. 
Bastedo at the College of Physicians and Surgeons (Columbia 
University), New York. 

A. So Blumgarten. 
1114 Madison Ave., 
New York, 



TABLE OF CONTENTS 

PAGE 

Preface vii 

PART I— PHARMACY, CLASSIFICATION AND 
ADMINISTRATION 

CHAPTER I 
Introduction 1 

CHAPTER II 
Systems of Weights and Measures 29 

CHAPTER III 
Solutions 38 

CHAPTER IV 
The Preparation of Doses 61 

CHAPTER V 
The Administration of Medicines 78 



PART II— DRUGS USED PRINCIPALLY FOR THEIR EF- 
FECTS ON THE STOMACH AND INTESTINES 

CHAPTER VI 
Acids and Alkalies 103 

CHAPTER VII 

DiGESTANTS . 127 

CHAPTER VIII 

Bitters, Carminatives and Emetics (Gastric Stimulants) . . 133 

CHAPTER IX 

Cathartics (Intestinal Stimulants) 147 

CHAPTER X 
Anthelmintics 176 

XV 



xvi CONTENTS 

PART III— DRUGS ACTING PRINCIPALLY ON THE 
BLOOD AND CIRCULATION 

CHAPTER XI 

PAGE 

Haeaiatinics (Blood Stimulants) 187 

CHAPTER XII 
Circulatory Stimulants 211 

CHAPTER XIII 
Circulatory Depressants 247 

PART IV— DRUGS ACTING ON THE RESPIRATORY 

SYSTEM 

CHAPTER XIV 

Drugs Acting on the Respiratory Organs ....... 261 

PART V— DRUGS ACTING ON THE CENTRAL NERVOUS 

SYSTEM 

A.— DRUGS WHICH STIMULATE THE CENTRAL NERVOUS 

SYSTEM 

CHAPTER XV 

Physiology of the Nervous System 272 

CHAPTER XVI 
Brain and Spinal Cord Stimulants 292 

B.— DRUGS WHICH DEPRESS THE CENTRAL NERVOUS 

SYSTEM 

CHAPTER XVII 
Brain and Spinal Cord Depressants 304 

CHAPTER XVIII 
General Anaesthetics 346 

CHAPTER XIX 
Hypnotics 360 



CONTENTS xvii 

CHAPTER XX 

PAGE 

Antipyretics 382 

CHAPTER XXI 
Antispasmodics (Antihysterics) 392 

PART VI— DRUGS WHICH ACT UPON THE PERIPHERAL 
NERVE ENDINGS 

CHAPTER XXII 

Stimulants of Nerve Endings 397 

CHAPTER XXIII 

Depressants of Secretory and Motor Nerve Endings . . . 409 

CHAPTER XXIV 

Local Anaesthetics (Depressants of the Sensory Nerve End- 
ings) 433 

PART VII— SUBSTANCES WHICH IMPROVE 
NUTRITION 

CHAPTER XXV 
Substances which Improve Nutrition 449 

PART VIII— DRUGS ACTING ON THE UROGENITAL 

SYSTEM 

CHAPTER XXVI 

Diuretics (Kidney Stimulants) . . ' 466 

CHAPTER XXVII 
Drugs which Act on the Uterus 478 

PART IX— SPECIFICS 

CHAPTER XXVIII 
Specifics 492 

CHAPTER XXIX 
Serums and Vaccines 532 



xviii CONTENTS 

CHAPTER XXX p^^j. 

Organic Remedies 541 

PART X— DRUGS ACTING PRINCIPALLY ON THE SKIN 
AND MUCOUS MEMBRANES (LOCAL REMEDIES) 

CHAPTER XXXI 
Astringents 554 

CHAPTER XXXII 
Antiseptics 581 

CHAPTER XXXIII 
Drugs acting chiefly on the Skin 623 

PART XI— MISCELLANEOUS 

CHAPTER XXXIV 

Flavoring Substances 641 

CHAPTER XXXV 
Prescription Reading 646 

Appendix (Harrison Law) 653 

Index 656 



MATERIA MEDICA FOR NURSES 



MATERIA MEDICA FOR 
NURSES 

PART I.-PHARMACY, CLASSIFICATION AND 
ADMINISTRATION 

CHAPTER I 

INTRODUCTION 

Materia Medica is the study of the substances used in 
treating the sick. Most of these substances are drugs; man}^ 
of them, however, are serums, solutions of bacteria, or ex- 
tracts of organs. The subject may be divided into three 
distinct branches: 

Materia Medica proper, or pharmacognosy, which deals with 
the botanical, chemical and physical properties of drugs. 

Pharmacology or pharmacodynamics, which is the study 
of the action, or the effects of drugs; that is, the study of 
the changes which drugs produce in the activities of the 
hody, or of its organs. 

Therapeutics, which deals with the treatment of disease. 

For the nurse, only the first two branches of Materia 
Medica are of importance, as she is never called upon to 
treat patients, nor should she ever do so without orders from 
a physician. She should know, however, the properties 
and effects of drugs, for the physician relies upon her to 
see that their desirable effects are obtained, and that no un- 
usual or poisonous sjonptoms occur. When these symp- 
toms do occur, she should be able to recognize them as 
early as possible. 

SOURCE OF DRUGS 

Drugs are obtained from the mineral, vegetable, and 

animal kingdoms. The drugs obtained from the vegetable 

1 



2 MATERIA MEDICA 

kingdom are made from various parts of plants, such as the 
roots, the bark, the flowers, the fruit or the sap; and in 
some instances from the entire plant. 

From the crude plant, various preparations are made, so 
as to be able to regulate the strength, or to measure the dose 
of the drug more accurately; in some instances to make the 
drug more palatabie, or to disguise its unpleasant taste. 

PHARMACEUTICAL PREPARATIONS 

The preparations of drugs are made by either physical or 
chemical means. In the preparations made by purely 
physical means the drug itself is not changed. The sub- 
stance is merely ground up and prepared in some special 
form, or dissolved in a fluid such as water, alcohol, etc. Prep- 
arations made in this way are frequently called Galenicals, 
because they were used extensively by Galen, a great phy- 
sician who lived several centuries ago. 

The chemical preparations are those made by decomposing 
the drug so as to obtain some of the active substances. The 
active principles of drugs, such as alkaloids and glucosides, 
are prepared in this way. 

PHYSICAL PREPARATIONS 
SOLID SUBSTANCES 





For Internal Use 


Common name 


Latin name 


Concentrated 


Extract 


Extractum 


Preparation 






Powder 


Pulvis 


Pill 


Pilula 


Capsule 


Capsula 


Tablet 


Tabella 


Cachet 


Cachet 


Lozenge 


Trochiscus 


Vescette 


Vescette 


Confection 


Confectio 


Sterule 


Sterula 




Paper 


Charta 



INTRODUCTION 3 

For External Use 

Common name Latin name 

Ointment Unguentum 

Cerate Ceratum 

Plaster Emplastrum 

Suppository Suppositorium 

Lamella Lamella 

DEFINITIONS OF SOLID PREPARATIONS 
For Internal Use 
Concentrated Preparation 
Extracts are solid preparations obtained by dissolving 
the drug in alcohol or water, and then evaporating the solu- 
tion. The resulting sediment is the extract, and is usually 
about four or five times as strong as the crude drug itself. 

Physical Preparations of Various Forms 

Powders are crude drugs ground up into a powder and 
used in this form. 

Pills are drugs moulded in the form of a very small sphere. 
They should always be fresh, for when they are exposed to 
the air they may become so hard that they cannot be dis- 
solved by the juices of the stomach or intestine, and will 
then produce no effects. 

Capsules are drugs made up into a small cylindrical gelatin 
container which disguises the taste of the contained substance. 

Tablets are dried powdered drugs which have been com- 
pressed into small discs. They are usually prepared in an 
aseptic manner so that they can be given hypodermically. 
Tablets are very easily dissolved. 

Cachets are small disc-like pieces of rice paper which 
are stuck together, enclosing between them the drug to be 
administered. 

Lozenges are flat discs consisting of a drug made up with 
sugar or tragacanth or any demulcent substance. 

Vescettes are effervescent salts compressed into a tablet. 

Confections are preparations of drugs made up to dis- 
guise the taste of unpleasant tasting substances. They are 
usually made up with honey and sugar. 



4 MATERIA MEDICA 

Sterules are glass capsules containing a sterile solution of a 
drug. They are used for hypodermic administration. 

Papers are small pieces of paper impregnated with medi- 
cinal substances. 

For External Use 

Ointments are preparations which are usually made up 
with lard, vaseHne, or oils. They are applied to the skin 
and are melted by the heat of the body and the drugs are 
then absorbed. 

Cerates are preparations of drugs made up with white wax. 

Plasters are preparations which are made up with resins, 
wax or lead plaster, and spread upon coarse muslin or white 
leather. They are applied to the skin, the mixtm-e of the 
drugs which they contain is dissolved by the heat of the 
body, and the drugs are then absorbed. 

Suppositories are cone-shaped preparations of a drug 
made up with cocoa butter. 

Lamellae are small gelatin discs containing medicinal 
substances, which are inserted between the lower eyelid and 
the eyeball. 

FLUID PREPARATIONS 

The fluid preparations may be divided into the following 
two groups: 

(a) Concentrated Preparations: These are made by dis- 
solving the drug in a fluid in which some of the extraneous 
matter is not soluble. The resulting fluid contains the drug 
in a more concentrated form and is therefore more active, 

(b) Solutions : Fluids in which the entire drug is dissolved. 

Concentrated Preparations 

Common name Latin name 

Fluidextract Fluidextractum 

Tincture Tinctura 

Infusion Infusum 

Decoction Decoctum 

Wine Vinum 

Oleoresin Oleoresina 



INTRODUCTION 5 

Solutions 
In water In alcohol 

Common name Latin name Common name Latin name 
Water Aqua 

Solution Liquor Spirit Spiritus 

Mucilage Mucilago 

In sugar In vinegar 

Syrup Syrupus Vinegar Acetum 

Elixir Elixir In glycerine 

Glycerite Glyceritum 

Suspensions 

(Undissolved) 
Common name Latin name 

Emulsion Emulsum 

Mixture Mistura 

Special Methods of Preparation 

Oleate Oleatum 

Liniment Linimentum 

DEFINITIONS OF FLUID PREPARATIONS 
Concentrated Preparations 

Fluidextracts are concentrated fluid preparations of drugs 
made by dissolving the crude plant drug in the fluid in which 
it dissolves most readily. The strength and character of the 
fluid used therefore varies with each drug, and may be 95% 
alcohol, alcohol and glycerin, or dilute alcohol of various 
strengths. Fluidextracts, however, are always 100% in 
strength; that is, m. i. contains gr. i and 1.0 c.c. contains 
1.0 gm. of drug. 

Tinctures are dilute alcoholic extracts of drugs varying 
in strength from 10 to 20%. The Pharmacopoeias of all 
countries now agree on 10% as the standard strength for 
tinctures of all powerful drugs. Tinctures of weak drugs are 
often 20% in strength. Tincture of iodine and tincture of 
iron chloride, which are not extracts, are alcoholic solutions 
and not real tinctures. When another fluid besides alco- 



6 MATERIA MEDICA 

hoi is contained in the tincture this is added to the name; 
for example, when the alcohol contains ammonia, the tinc- 
ture is called an ammoniated tincture. 

Infusions are preparations of plant drugs made by pouring 
hot or cold water over them, and then allowing the drug 
to steep. The strength of an infusion depends on the quan- 
tity of drug used to a definite amount of water. 

Decoctions are preparations of plant drugs made by boil- 
ing them in water and then straining the fluid. 

Wines are preparations of drugs dissolved in wine. They 
are made like the tinctures but have a better flavor. 

Oleoresins are extracts of plant drugs made by dissolving 
the crude drug in acetone. They contain the resinous sub- 
stance and oils of the plant. 

Solutions 
In Water 

Waters are solutions of substances which evaporate very 
easily. 

Solutions are drugs dissoved in water. Solutions usually 
contain substances which do not evaporate easily. 

Mucilages are gummy di'ugs dissolved in water. 

In Alcohol 

Spirits are preparations of volatile substances dissolved in 
alcohol. 

In Sugar 

Syrups are preparations of drugs made with sugar and 
water. 

Elixirs are palatable preparations of drugs. They are 
made up with alcohol, sugar and some aromatic substance. 
They usually contain very small quantities of the drug. 

Solutions in Other Fluids 

Vinegars are medicinal substances dissolved in a weak 
solution of acetic acid, or vinegar. 

Glycerites are preparations of drugs dissolved in glycerine. 



INTRODUCTION 7 

Oleates are medicinal substances dissolved in oleic acid, 
which is an ingredient of many oils and fats. Oleates are 
more easily absorbed than ointments. 

Liniments are liquid or soft preparations of drugs which 
are applied by rubbing on the skin. The drug is usually dis- 
solved in alcohol or in an oily substance. 

Suspensions 

In the following preparations the drug is contained in the 
fluid in fine particles : 

Mixtures are preparations consisting of several drugs 
mixed together. Fluids containing a substance which does 
not dissolve are also called mixtures. 

Emulsions are solutions of oily substances which contain 
the oil divided up into fine globules. They are usually of a 
milky color and consistency. 

OFFICIAL AND UNOFFICIAL PREPARATIONS 
Official Preparations 

In order that all drugs shall be uniformly prepared, and 
standards maintained for the strengths of the different prep- 
arations, a committee of physicians and pharmacists is ap- 
pointed in every country to regulate the strengths and 
m^ethods of preparation of all the drugs used in medical 
practice. This committee publishes a book known as the 
Pharmacopoeia, which contains a list of all the preparations 
of drugs whose ingredients, strengths and methods of prep- 
aration conform to a certain standard. Such preparations 
are called official preparations, and often have the letters, 
U. S. P. (United States Pharmacopoeia), B. P. (British 
Pharmacopoeia), etc., written after them. Some prepara- 
tions may be official in one country and not in another, 
though they may be used in both countries. 

Unofficial Preparations 

Since the Pharmacopoeia committee revises the Pharmaco- 
poeia only once in ten years, many drugs and preparations, 
are discovered in the meantime which are not listed. Many 



8 MATERIA MEDICA 

of these substances may be extensively used during that 
time, though they are not described in the Pharmacopoeia. 
These drugs are called unofficial preparations. Some of these 
unofficial preparations may be subsequently accepted by the 
Pharmacopoeia committee as conforming to its standards 
in strength, ingredients and action, and they then become 
official preparations. 

Other unofficial preparations may not be accepted by 
the Pharmacopoeia committee at all, though they may be 
extensively used. 

The United States Dispensatory is a private unofficial 
book containing a list of both official and unofficial prepara- 
tions, their ingredients, preparations, and their methods of 
preparation. The National Formulary contains a list of the 
unofficial substances and their methods of preparation. 

To keep pace with the new drugs that are constantly being 
discovered, The American Medical Association publishes 
annually a book of ^^New and Non Official Remedies'' which 
contains a list of the new drugs that have proved to be 
valuable and efficient. These remedies are often distin- 
guished by the letters N. N. R. placed after them. 

ACTIVE PRINCIPLES 

It was formerly thought that certain plants cured disease 
because of magic or supernatural powers which they 
possessed; and unless certain formalities were compHed 
with in obtaining these drugs, they were not supposed to 
have any curative effect. 

For example, in obtaining the drug hyoscyamus (henbane) 
it was necessary that the drug be dug up with certain pre- 
cautions, and addressed as follows: 

^^ Sacred herb, I summon thee to the house (of my patient) 
to stop the Rheum of his feet, etc. I conjure thee by the 
great name Jaoth Sabaoth." We now know that this drug 
has certain active principles (the alkaloids, atropine, hyo- 
scyamine, hyoscine) which are responsible for its effects. ' 

In gathering other drugs the following formula was used: 
^ Delve round the root and take it up with thy two hands 



INTRODUCTION 9 

turned upward; sing over it nine paternosters^ and in the 
ninth, at the words 'Dehver us from eviV snap it up/' etc. 
Frequently it was necessary to mention the name of the 
sick man and his father, etc., etc. 

We now know, however, that all drugs cause changes in 
the activity of the body by virtue of certain chemical sub- 
stances which they contain. 

These substances which are contained in the crude plant 
are called active principles. When they are extracted from 
the plant they produce the same but more reliable effects as 
the crude drug itself. Nearly all the active principles be- 
long to the following groups of chemical substances: 

1. Plant or Organic Acids 

2. Alkaloids 

3. Glucosides 

4. Saponins 

5. Oils 

6. Tannins 

7. Resins 

8. Oleoresins 

9. Balsams 

Plant acids: Many of the fruits contain organic acids 
(acids containing carbon), thus lemons contain citric acid, 
grapes, tartaric acid, etc. 

Alkaloids: An alkaloid is an active principle, found in 
plant drugs or made chemically, which acts like an alkali. 
(An alkah is a chemical substance which combines with acids 
to form salts. It turns red litmus paper blue). Alkaloids 
also combine with acids to form salts, which have the same 
effects as the alkaloids themselves. For example, when 
sodium, an alkali, is added to sulphuric acid, a salt, so- 
dium sulphate, is formed. When morphine, an alkaloid, is 
added to sulphuric acid, a salt, morphine sulphate, is formed. 
I Chemically, alkaloids consist largely of carbon, hydrogen 
and nitrogen. 

! The alkaloids do not dissolve readily in water, but their 
salts are very soluble and are the preparations principally 
used. 



10 :^IATEPJA MEDICA 

The alkaloids and their salts form a precipitate when 
tannic acid or potassium permanganate is added to them, 
but this precipitate is not soluble and is therefore not ab- 
sorbed, thus making the alkaloids inactive. For this reason 
tannic acid or potassium permanganate are used as antidotes 
in cases of poisoning by any of the alkaloids. 

The names of all the alkaloids end ui " ine." 

Glucosides are active principles of plant drugs which al- 
ways form a sugar (usually glucose, or grape sugar^ hence 
the name), when decomposed by acids, heat, bacteria or 
other agents. They are neutral substances, because chem- 
ically, they are neither acids nor alkahes. The names of all 
glucosides usually end in "in." 

Saponins: These are glucosides which have some of the 
properties of soap: that is, they foam when mixed with 
water. They are found m a nmnber of plants such as sar- 
saparilla, quillaja bark, etc. They are not absorbed, but 
merely act locally by iujuring the tissues with which they 
come in contact rirritatiag'). When given internally they 
cause nausea, vomitiug and diarrhoea. 2vlany drugs pro- 
duce these effects because of the saponins which they 
contain. 

Oils: These are substances which have a characteristic 
greasy feel and with whose physical characteristics the reader 
is no doubt familiar. Chemically they consist of a mixture of 
three substances: oleui, stearin and palmitui, the three ele- 
mentary- fats. Each of these substances consists m turn of 
a fatty acid (complex organic acidj combined with glycerin. 
Oils are of two kinds : fixed and volatile. 

Fixed oils comprise most of the oils in common use, such 
as ohve, cottonseed and castor oil. The fixed oils do not 
evaporate easily. They are decomposed iu the iatestiae by 
the digestive juices iato a fatt^' acid and glycerin. The 
rancidity of fats and oils is due to a similar decomposition 
by heat. 

The oils are utilized as foods, and medicinally they are 
very soothing substances. ^Nlany oils, however, such as 
castor oil and croton oil, when decomposed in the iates- 
tiQes form fatty acids which act as drugs. 



INTRODUCTION 11 

Volatile or essential oils are oils which evaporate very 
readily. They usually have a very pleasant aroma which 
gives the pleasant odor to the plants from which they are 
obtained. The most common volatile oils are oil of winter- 
green, oil of peppermint, oil of camphor, etc. When a vola- 
tile oil is allowed to stand for some time, some of its con- 
stituents evaporate, leaving a thick film which is called a 
stearoptene. 

Tannins: These are substances whose chemical composi- 
tion has not yet been determined, but they seem to be acids. 
They are found in the bark of many trees, in witch hazel and 
other plants. They form insoluble precipitates with alkaloids 
and proteins, and are therefore used principally as astrin- 
gents. 

Resins : These are thick sticky substances which form the 
sap of many trees. Most of these substances can be dis- 
solved in alcohol but not in water. Some resins are solid; 
for example, the rosin used by violinists. 

Oleoresins: These are substances found in many plants 
which consist of a resin combined with a volatile oil. They 
are usually prepared by dissolving the crude plant in 
ether. 

Balsams: These are resins or oleoresins which contain 
benzoic or cinnamic acid. 

Enzymes or Ferments: These are the active principles of 
man}^ animal and vegetable substances which are capable of 
producing very definite effects. The chemical composition 
of these substances is unknown but they are destroyed by 
moist heat of a temperature of about 60°C. The best known 
enzymes are pepsin, the active principle of gastric juice, 
trypsin, one of the active ferments of pancreatic juice, sinal- 
hin, the active ferment of white mustard and sinigrin, the 
ferment of black mustard. Myrosin and emulsin are fer- 
ments which are found in the seeds of various plants. Since 
enzymes are destroyed by heat, preparations which depend 
upon ferments for their effects should not be given in hot 
liquids. 

Hormones: These are the active principles of various 
glands in the body such as the thyroid, the pituitary, the 



12 MATERIA MEDICA 

spleen or the adrenal glands. These glands secrete these 
active elements into the blood stream which then have a 
profound influence on the growth, development and metab- 
olism of the individual. Only very few of these specific 
hormones have as yet been isolated. Adrenalin is one of the 
hormones of the adrenal gland. Pituitrin is one of the 
hormones of the pituitary gland. 

TYPES OF DRUG ACTION 

Any drug may cause either local or general effects. 

Local effects result from the direct application of a drug to 
a tissue or organ. The drug combines with the albumins 
of their cells forming an albuminate. If this albuminate 
does not readily dissolve in the surrounding fluids it protects 
the cells from further action of the drug. Such an effect is 
called an astringent action. If the albuminate is readily 
dissolved in the surrounding fluid, more of the drug combines 
with the cells until they may be completely destroyed. Such 
an effect is called irritation. Substances like caustic soda 
produce such effects. 

General or systemic effects are the effects that result 
from the action of a drug upon an organ or tissue remote 
from the site of application. To produce a general effect 
a drug must circulate in the blood stream. 

The process whereby a drug enters the blood stream is 
called absorption. The process w^hereby a drug is eliminated 
from the body is called excretion. A drug may be injected 
directly into the blood or find its way into the blood from the 
subcutaneous tissues or from the stomach or intestines. 
When the drug enters the blood stream the effects upon the 
cells will result from one of the following actions: 

Physical action, Chemical action or Salt action 

Physical Action; This is an action of a drug that results 
when some of the constituents of a cell are temporarily 
dissolved in a fluid drug which is brought to the cell by the 
blood stream. When the drug is eliminated from the body 
tihe cell constituents become normal again and the effects 



INTRODUCTION 13 

paiss off. For example, the effect of ether on the brain is 
beheved to be due to the fact that the ether dissolves out 
some of the constituents of many of the brain cells, thus 
modifying their function and producing unconsciousness 
and insensibility to pain. 

Chemical Action: This is the way in which most drugs 
probably produce their effects. They probably cause a 
chemical combination of the drug with some of the constit- 
uents of the cells of one or of a number of organs. We do 
not yet know the nature of this chemical combination, but 
we do know in the case of most drugs where these changes 
occur. 

Salt Action: Salts, sugars, acids and alkalies act in f is- 
tinctive manner. This type of action is manifested .spe- 
cially by salts and is therefore called '^salt action." 

When salts or any of these substances enter the stomach 
or intestine they withdraw fluid from the blood and tissues 
thus diluting them. This process is called osmosis, and oc- 
curs whenever two salt solutions of a different concentra- 
tion are separated by an animal membrane. 

When the salt has been thoroughly diluted by the fluid 
withdrawn from the tissues, part of it is then absorbed. Some 
salts, however, are very slowly absorbed and others not at 
all. The absorbed salt now circulates in the blood stream 
until it reaches the various cells of the body in the lymph 
with which these cells are constantly bathed. If this lymph 
now contains a greater percentage of salt than the cell, water 
is withdrawn from the cell. On the other hand, if the per- 
centage of salt in the surrounding lymph is less than that 
in the cells, the cells absorb water from the lymph. This 
process is called diffusion; it differs from osmosis since it 
occurs without the intervention of an animal membrane. 
The activity of the cells of some organs such as those of the 
kidney may thus be made more active by a number of salts. 

Selective Action: No drug affects all the organs or tissues 
of the body. The ability of a drug to affect only certain 
organs or tissues is called selective action. Thus strychnine 
usually acts only upon the cells of the spinal cord, morphine 
upon the cells of the brain, etc. 



14 MATERIA MEDICA 

Synergistic Action: This is the abihty of a drug to aid 
the effect of another. 

Antagonistic Action: This is the abihty of a drug to an- 
tagonize the effect of another. 

Therapeutic Action: This is the effect a drug produces in 
diseased conditions. 

Physiological Action: This is the effect a drug has on a 
normal animal. 

Side Actions are the effects that result from a drug other 
than those desired. 

Empiric Action: This is the effect that has followed the 
use of a medicine in disease but which has not been corrob- 
orated by laboratory experiments. 

Poisonous or Toxicological Action: This is the effect that 
results from an overdose of a drug. 

IDIOSYNCRASY OR UNTOWARD EFFECT 

Some individuals get unusual, opposite, even poisonous 
effects from ordinary doses of certain drugs. Occasionally 
even large doses of certain drugs produce no appreciable 
effects. Such effects are called idiosyncrasies or untoward 
effects. They occur in two forms : 

(a) Idiosyncrasy of Effect: This is a condition when small 
or ordinary doses of a drug cause no effects, unusual, oppo- 
site or poisonous effects. For example, morphine is a drug 
which usually produces sleep and quiets the patient. In 
some individuals it causes excitement and wakefulness. 

(b) Idiosyncrasy of Dose: This is a condition where even 
large doses of a drug cause no effects at all. 

CUMULATIVE ACTION 

Some drugs are excreted much more slowly than they are 
absorbed. If such drugs are administered for any length of 
time, a part of each dose always remains in the body. After 
prolonged administration so much of the drug may accu- 
mulate in the body that poisonous effects may occur. The 
poisonous effects that result from a drug accumulating in the 



INTRODUCTION 15 

body as a result of the elimination being slower than the 
absorption are called cumulative effects. 

Drugs which are apt to cause cumulative effects when 
given continuously, should be administered with periods of 
intermission during which the drug is stopped, or the dose 
should be gradually reduced. For example, digitalis, which 
may cause cumulative effects, should be given in diminishing 
doses or with periods of intermission when it is discontinued 
entirely. 

CLASSIFICATION 

All drugs affect the body, or an organ of the body, by 
either increasing or lessening its activity. 

A drug which increases the activity of the body, or any of 
its organs, is called a stimulant; the act of increasing the 
activity is called stimulation. 

A substance which lessens the activity of the body, or 
any of its organs, is called a depressant; the act of lessening 
the activity is called depression. 

When the activity of an organ is increased to such an 
extent that it is overacting, it is said to be overstimulated. 

A substance which injures the cells of a tissue or organ is 
called an irritant; the effect of such a substance is called 
irritation. 

The effects produced by overstimulation may be those of 
lessened activity or depression; since, by overacting, an 
organ may become exhausted. For example, the poisonous 
effects of some drugs, which ordinarily increase the activity 
of the body, may be those of lessened activity. 

A poisonous substance is injurious to the body by causing 
great overactivity of one or several organs of the body (irri- 
tation), or by greatly lessening the activity (depression). 

Most drugs increase or lessen the activity only of one 
or a number of organs of the body. 

We can classify all drugs, therefore, according to the effect 
produced on the activity of the body, or on any of its organs 
(stimulation or depression), and according to the organs 
they principally affect, or for which they have a selective 
action. 



16 



MATERIA MEDICA 



CLASSIFICATION OF DRUGS 

(Only the most important drugs are here given) 

STIMULANTS DEPRESSANTS 

Increasing activity Lessening activity 

Drugs Acting on Gastro Intestinal Tract 

The Stomach 



To replace active substances 


To neutralize acid 


Acids 


Digestants 


Alkalies 


Hydrochloric 


acid Pepsin 


Sodium 




Sulphuric acid Pancreatin 


Potassium 




Nitric acid 




Ammonium 
Calcium 
Magnesium . 


■Sal 


Bitters 






Gentian 


Calumba 




Serpentaria 


Berberis 




Capsicum 


Cardamom 




Cinchona 


Ginger 




Emetics 




Ipecac 


Apomorphine 

Intestinal Tract 




Cathartics 




Cascara 


Mineral Oil 




Agar Agar 


Castor Oil 




Senna 


Rhubarb 




Aloes 


Licorice 




Phenolphthalein Podophyllum 




Euonymus 


Scammony 




Croton Oil 


Colocynth 




Gamboge 


Jalap 




Elaterium 


Anthelmintics 






Drugs which Destroy Worms 




For Tape Worm 






Aspidium Kamala 




Cusso Granatum 




Pepo Pelletierine 





INTRODUCTION 17 

STIMULANTS DEPRESSANTS 

For Round Worm 
Santonin 
Spigelia 
Chenopodium 

For Thread Worm 
Quassia 
(Alum) 

For Hook Worm 

Thymol 

Naphthol 

(Calomel) 

Chenopodium 

Drugs which Affect the Blood and Blood Forming Organs 

Iron 

Arsenic 

Calcium Lactate 

Drugs which Affect the Heart 
Digitalis Group Aconite 

Strophantus Veratrum Viride 

Convallaria (Eserine) 

Squills (Pilocarpine) 

Strychnine 

Atropine (Belladonna Group) 
Camphor 
(Caffeine) 
Ammonia 

Drugs which Affect the Blood Vessels 
Epinephrine Amyl Nitrite 

Pituitary Extract Nitroglycerine 

(Ergotoxine) (Nitrite Group) 

Drugs which Affect the Respiration 
(Atropine) (Opium and Morphine) 

(Caffeine) (Chloroform) 

(Strychnine) (Chloral) 

(Camphor) (Aconite) 

(Dilute Hydrocyanic Acid) 

Note: Parentheses around the name of a substance mean that the effect 
under which it is grouped is not its principal effect. 



13 



MATERIA MEDICA 



STIMULANTS DEPRESSANTS 

Drugs which Affect the Nervous System 

The Brain 

Caffeine Bromides 

(Coca) Alcohol 

(Atropine) 



To Relieve Pain 
Analgesics 
Opium and Morphine 
Cannabis Indica 
Acetanilid 

Antipyrine Act also as 
Phenacetine Antipyretics 
Pyramidon 
and similar unofficial products 



To produce anaesthesia 

Chloroform 
Ether 

Ethyl Chloride 
Nitrous Oxide 

To Produce Sleep 
Hypnotics 

Chloral Group 

Trional 

Tetronal 

Veronal 

Sulphonal 

Paraldehyde 

Chloretone 

Hypnal 

and other similar substances 



Spinal Cord 



Strychnine 



INTRODUCTION 19 

STIMULANTS DEPRESSANTS 

Drugs Acting on the Nerve Endings 

Sensory Nerves 

Local Anaesthetics 

Cocaine and derivatives 
Menthol 
Anaesthesin 
Orthoform 
Hydrocyanic acid 

Efferent Nerves 
Drugs Acting on the Secretory Glands 

Pilocarpine (Atropine) 

(Eserine) (Camphor) 

(Ipecac) 

Drugs Acting on the Involuntary Muscles 

Eserine or Physostigmine Atropine 

Gelsemium 
Lobelia 

Drugs Acting on the Kidneys 

Diuretics 

Caffeine 

Theobromine 

Diuretin 

Agurin 

Potassium Acetate 

Potassium Citrate 

Potassium Bitatarate 

Potassium Nitrate 

Sodium Acetate 

Sodium Nitrate 

(Digitahs Group) 

Mercury (Calomel and Blue Pill) 



20 MATERIA MEDICA 

STIMULANTS DEPRESSANTS 

Drugs Acting on the Genital Organs 

Ergot Viburnum 

Hydrastis (Hydrastinine) 

Pituitary Extract 

Rue 

Tansy 

Savine 

(Quinine) 

Specifics 

Drugs which Cure Particular Diseases (Usually by 
Destroying the Cause) 

For Malaria 

Quinine 
(Arsenic) 

For Syphilis 

Mercury 

Salvarsan 

Iodides 

For Rheumatism 

Sodium Salicylate 

Salicylic Acid 

Salicin 

Salol 

Aspirin 

and their derivatives 

For Gout 

Colchicum 
Atophan 

For Araoehic Dysentery 
Emetine 



INTRODUCTION 



21 



Serums, Antitoxins, and Vaccines 

Antistreptococcus Serum 
Antipneumococcus Serum 
Diphtheria Antitoxin 
■ Tetanus Antitoxin 
TubercuUn 

Staphylococcus Vaccine 
Streptococcus Vaccine 
Smallpox Vaccine 
Bulgaric Bacilli Preparations 
Dunbar's Serum 
Pollen Vaccine 



Organic Substances 

Drugs Obtained from Various Organs of Animals 

Thyroid Extracts 
(Pituitary Extracts) 
Ovarian Extracts 
(Epinephrine) 

Drugs which Act on the Skin and Mucous Membranes 

Astringents 

(Drugs which Contract Tissues and Check Secretions of 
Mucous Membranes) 



Metals 



Lead 

Copper 

Zinc 

Aluminium 

Silver 

Bismuth 

Barium 



Salts 



Vegetable Substances 

Tannic Acid 

GaUic Acid 

Tannigen 

Tannalbin and similar substances 



22 MATERIA MEDICA 

Antiseptics 

Drugs which Check the Growth of Bacteria 

Carbolic Acid Iodoform 

Creolin Eucalyptus 

Lysol Ichthyol 

Sulphur Dioxide Urotropin 

Calcium Chloride Salol 

Bichloride of Mercury Naphthol 

Potassium Permanganate Thymol 

Hydrogen Peroxide Copaiba 

Boric Acid Cubebs 

Formalin and numerous other similar sub- 
stances 

Counterirritants 

Rubefacients 

Drugs which Cause Redness of the Skin 

Mustard 
Turpentine 
Arnica 
and other similar substances 

Vesicants 

Drugs which Produce Blisters 

Cantharides 
(Mustard) 

Pustulants 

Croton Oil 
Tartar Emetic 



IIMTRODUCTION 23 

Caustics 

Drugs which are Used to Destroy Tissues 

Mineral Acids 
Glacial Acetic Acid 
Caustic Potash 
Caustic Soda 
and strong solutions of the metallic astringents 

Demulcents and Emollients 

Drugs which Soften and Protect the Skin or Mucous 
Membrane 

Vaseline 
Cocoa Butter 
Olive Oil 
Lanolin 
Glycerin 
Starch 
Flaxseed 
Acacia 
and other mucilaginous substances 

Miscellaneous Substances 

Flavoring Substances 

Peppermint 
Spearmint 
Saccharin, etc. 



24 MATERIA MEDICA 

CLASSIFICATION OF EFFECTS 

Special names are given to drugs causing certain ef- 
fects. The following is a list of definitions of the names 
given to groups of drugs according to their most important 
effects : 

Absorbents are substances which increase the absorption 
of diseased tissue. 

Alteratives are drugs whose mode of action is unknown, 
but which improve the nutrition of the tissues, and help to 
absorb diseased tissues, thereby restoring them to their 
normal condition. 

Anaesthetics are drugs which produce insensibility to 
pain. 

Local Anaesthetics are drugs which produce insensibility 
to pain at the site of application. 

General Anaesthetics are drugs which produce insensi- 
bility to pain all over the body. These drugs also pro- 
duce unconsciousness. 

Analeptics are substances which bring about health and 
strength. 

Analgesics are drugs which relieve pain when absorbed into 
the blood. 

Anodynes are drugs which relieve pain when applied 
locally. They are usually milder in action than the analges- 
ics. 

Antacids are drugs which neutralize acids. They are 
usually given to neutralize the acid in the stomach. 

Antiemetics are drugs which check vomiting. 

Anthelmintics are drugs which destroy or expel worms. 

Antiarthritics are drugs which reheve gout. 

Antilithics are drugs which prevent the formation of 
stones. 

Antiperiodics are drugs which relieve regular attacks of 
chills and fever, as in malaria. 

Antipyretics are drugs which reduce fever. 



INTRODUCTION 25 

Antiseptics are substances which check the growth of 
bacteria. 

Antisialogogues are drugs which check the flow of saHva. 

Antispasmodics are drugs which lessen contractions of 
muscles, and also lessen convulsions. The term is also 
applied to drugs which lessen nervousness, because of the 
tremors of the muscles which often occur in these condi- 
tions. 

Antizymotics are drugs which check the action of germs. 

Aperients are substances which produce mild movements 
of the bowels. 

Aromatics are spicy substances which increase the secre- 
tion of the stomach and intestines. 

Astringents are drugs which contract or harden tissues. 

Bitters are drugs which increase the appetite because of 
their bitter taste. They also increase the flow of gastric 
juice. 

Cardiac Stimulants are drugs which increase the activity 
of the heart, so that it beats stronger and faster. 

Cardiac Depressants are drugs which lessen the heart action 
so that the heart beats slower and weaker. 

Carminatives are drugs which produce a feeling of com- 
fort in the stomach and relieve the formation of gas in 
the stomach and the intestines. They also increase the 
appetite. 

Cathartics are drugs which cause movements of the 
bowels. 

Caustics are substances which burn or destroy tissues. 

Cholagogues are drugs which cause movements of the 
bowels, the stools being colored with bile. They are said to 
iucreaas the flow of bile. 

Ceiebral Stimulants are drugs which increase brain activity 
making the patient more active, brighter and more talka- 
tive (in large doses such drugs may produce delirium, 
hallucinations, convulsions, etc.). 

Cerebral Depressants are drugs which lessen brain ac- 
tivity. The patient is dull and less active. In large dosea 
they may produce sleep. 

Convulsants are drugs which produce convulsions. 



26 MATERIA MEDICA 

Correctives are substances used to make unpleasant drugs 
more pleasant to the taste. 

Counterirritants are drugs which act on the skin. They 
cause redness of the skin, thus relieving inflammation in re- 
mote organs or tissues. By acting on the nerve endings in 
the skin they also relieve pain in remote organs. 

Delirifacients are drugs v^hich increase the activity of the 
brain, and which often cause delirium. 

Demulcents are bland slippery liquids, used to coat, protect 
and lubricate a mucous membrane or surface of the body. 

Deodorants are remedies which destroy unpleasant odors. 

Depilatories are substances used to remove hair. 

Depresso-motors are drugs which lessen the impulses for 
motion sent from the brain or spinal cord. 

Depurants are drugs which increase the excretions of the 
body and thereby purify it. 

Detergents are substances which clean wounds. 

Diaphoretics are drugs which cause perspiration. 

Digestives or Digestants are substances which aid the 
digestion of food. 

Disinfectants are drugs which check the growth of bacteria. 

Diuretics are drugs which increase the flow of urine, both 
in amount and frequency. 

Ecbolics are drugs which contract the uterus and expel 
its contents; thereby producing abortion, or assisting labor. 

Emetics are drugs which produce vomiting. 

Emmenagogues are drugs which bring about menstrua- 
tion. 

Emollients are drugs which soften and protect the sur- 
face of the body. 

Errhines are drugs which increase the nasal secretions, 
and produce sneezing. 

Epispastics or Escharotics are drugs which produce bHsters 
and destroy the skin of the area over which they are ap- 
phed. 

Excito-motors are drugs which increase the impulses for 
motion, that are sent out from the brain or spinal cord. 

Expectorants are drugs which increase coughing and 
bronchial secretions. 



INTRODUCTION 27 

Evacuants are drugs which move the bowels. 

Febrifuges are drugs which reduce fever. 

Galactogogues are drugs which increase the secretion oi 
milk. 

Haemostatics are substances which check bleeding. 

Hydragogues are drugs which produce frequent watery 
movements of the bowels. 

Hypnotics are drugs which produce sleep. 

Laxatives are drugs which produce mild movements of the 
bowels. 

Myotics are drugs which narrow (contract) the pupil of 
the eye. 

Mydriatics are drugs which widen (dilate) the pupil of 
the eye. 

Oxytocics are drugs which increase contractions of the 
uterus. 

Prophylactics are medicines which prevent the develop- 
ment of a disease. 

Purgatives are drugs which produce moderately active 
and frequent movements of the bowels. 

Refrigorants are substances which relieve thirst and cool 
the patient, in fever. 

Respiratory Stimulants are drugs which increase the depth 
and frequency of breathing. 

Respiratory Depressants are drugs which lessen the fre- 
quency and depth of breathing. 

Revulsants are drugs which draw blood from the deeper 
parts to the surface. 

Rubefacients are drugs which redden the skin by widening 
(dilating) the capillaries. 

Saline Purgatives are mineral salts which produce move- 
ments of the bowels. 

, Sedatives are drugs which lessen the activity of an organ 
or part of the body. 

Sialagogues are substances which increase the flow of 
saliva. 

Somnifacients or Soporifics are drugs which produce sleep. 

Specifics are drugs which cure particular diseases; usually 
by destroying or combining with, the causative agent. 



28 MATERIA MEDICA 

Stomachics are drugs which increase the activity of the 
stomach and intestines. They increase the appetite and aid 
digestion. 

Styptics are substances which stop bleeding. 

Sudorifics are drugs which produce sweating. 

Taenicides are drugs which destroy tape worms. 

Tonics are drugs which brace up the patient. They 
improve the health and vigor of every part of the body. 
They make the patient feel stronger, healthier, more ener- 
getic, and increase the appetite. 

Vermicides are drugs which destroy worms. 

Vermifuges are drugs which expel worms. 

Vesicatories or Vesicants are drugs which produce blisters. 

Vulneraries are drugs which promote the healing of wounds. 



CHAPTER II 

SYSTEMS OF WEIGHTS AND MEASURES 

There are two systems of measuring drugs: one is the 
French or Metric System^ the other is the Enghsh or Apothe- 
caries' System. 

The Metric system is the one which is used in all European 
countries; it has the following advantages: the units are 
divided into tenths, the units of length, volume and weight 
are similar, and the units of volume are equal to the units of 
weight. 

In this country, the Apothecaries' System is still used, 
but it is gradually being superseded by the Metric System ; 
and it is simply a question of time when the Apothecaries' 
System will be abandoned entirely. 

THE METRIC SYSTEM 

The elementary unit of measurement in the metric system 
is the one for length. This is the meter, which is about one 
ten-milHonth part of the distance from the equator to the 
north pole. It is equal to about 39.37 inches and is written 
as 1.0 m. 

TABLE OF LENGTH 

The unit is 1.0 one meter 

one tenth of the meter " 0.1 one decimeter 

" " " the decimeter " 0.01 one centimeter 

" " '' the centimeter " 0.001 one millimeter 

TABLE OF SURFACE 

A surface one meter long and one meter wide is called a 

square meter, 1.0 sq. m., which is the unit of surface. 

This is divided into one hundred square decimeters, each 

of which is again divided into one hundred square centi- 

2d 



30 MATERIA MEDICA 

meters. Each square centimeter is further subdivided into 
one hundred square miiiimeters. 

TABLE OF VOLUME 

The volume of a substance is the amount of space which it 
occupies. 

A quantity of space one meter long, one meter wide and 
one meter high, is one cubic meter, which is the unit of 
volume. 

This is divided into a thousand cubic decimeters, each of 
which is again divided into a thousand cubic centimeters 
and this in turn into a thousand cubic millimeters. 

TABLE OF CAPACITY 

In measuring fluids, we measure the quantity of fluid con- 
tained in a given space. The space which the fluid occupies 
varies with its character and temperature; thus an oily 
substance will occupy less space than boiling water. We 
therefore take the space occupied by water at 4° Centigrade 
as the standard. 

The unit of capacity is the liter, which is the amount of 
water contained in a volume of one cubic decimeter. 

The hter is divided into deciliters, centiliters and milliliters. 
The deciliter is a tenth, the centiliter a hundredth, and the 
milliliter a thousandth part of the liter. Since the lite?' 
occupies one cubic decimeter of space, the milliliter will occupy 
one thousandth part of that, and is therefore equivalent to the 
cubic centimeter, ? 

Tne new Pharmacopoeia has adopted the term mil, the 
abbreviation for milhliter, instead of c.c. (cubic centimeter). 
For example, 50.0 c.c. are now written 50.0 mils, 0.3 c.c. as 
0.3 mil, etc. 

The quantities of medicinal fluids which the nurse is called 
upon to measure are usually less than a liter, so that the 
measuring apparatus in ordinary use are graduated in cubic 
centimeters (c.c). In practice this is the unit ordinarily used 
in measuring fluids. 



SYSTEMS OF WEIGHTS AND MEASURES 31 

TABLE OF WEIGHT 

Solid substances are usually measured by weight. 

The unit for measuring weight is the gramme; which is 
the weight of one cubic centimeter of water at a tempera- 
ture of 4° Centigrade, written : 

1.0 gm. one gramme 
one tenth of the gramme is 0.1 gm. one decigramme 
one hundredth of the gramme '' 0.01 gm. one centigramme 
one thousandth of the gramme " 0.001 gm. one miUigramme 

Units greater than one gramme are given definite names, 
thus: 

10.0 gms. = 1 dekagramme 
100.0 gms. = 1 hectogramme 
1000.0 gms. = 1 kilogramme 

Since 1.0 (one gramme) is the weight of 1 mil or 1 cubic centi- 
meter of water, in expressing the quantities of fluids, which are 
measured by capacity, the denomination 1.0 means one mil or 
one cubic centimeter, 2.0, two mils or two cubic centimeters 
(2 c.c), etc. 

The nurse may overcome the difficulty of remembering the 
denominations of the metric system, if she remembers that 
the figures to the left of the decimal point, correspond to 
dollars, in our coinage system, and represent grammes in 
the metric system. The first figure to the right of the dec- 
imal point is the decigramme, the second centigramme, and 
the third milligramme, etc. This corresponds to dimes, 
cents and mills respectively in our coinage system. 

For example: $1.53 is one dollar and fifty-three cents in 
our coinage system, and if we write it without the dollar 
sign, in the metric system for measuring weight, we call it 
one gramme and fifty-three centigrammes. 

Practically, however, the only denominations used are the 
gramme, gm., and the milligramme, mg. Thus 5 deci- 
grammes are written as 0.5gm. (five-tenths of a gramme), 
O.OOgm. may be called 60 milhgrammes, etc. 



32 



MATERIA MEDICA 



APOTHECARIES' SYSTEM 
TABLE OF WEIGHT 

Measurement of Solids 

The unit of measurement is the grain, which is equal to 
0.065 gm. (sixty-five milhgrammes) in the metric system. 
The grain is written thus : gr. i. 

20 grains = 1 scruple S 
3 scruples or 60 grains = 1 dram 5 
480 grains or 8 drachms = 1 ounce § 
5760 grains or 12 ounces = 1 pound lb. 

TABLE OF CAPACITY 

Fluid Measurement 

The unit of measurement is the minim, which is equal to 
0.065 c. c. It is written m. i. 

60 minims = 1 fluid dram (3) 

8 fluid drams = 1 ounce (§) 

16 ounces = 1 pint (O) 

2 pints = 1 quart (qt.) 

4 quarts or 8 pints = 1 gallon (gal.) 



TABLE OF EQUIVALENTS 

Value of Metric Units in Apothecaries' Units 





Grain 


Dram 


Ounce 


Pound 


One milligramme . . . 


0.01543 


0.00026 






One centigramme . . . 


0.15432 


0.0026 


0.00032 




One decigramme .... 


1.54324 


0.0257 


0.0032 


0.00027 


One gramme 


15.43236 


0.257 


0.03215 


0.00270 


One kilogramme .... 


15432.3564 


257.206 


32.1508 


2.6792 



SYSTEMS OF WEIGHTS AND MEASURES 



33 



APPROXIMATE EQUIVALENTS OF METRIC UNITS 

Weight 
0.001 gm. = 



One milligramme 

One centigramme 0.01 

One decigramme 0.1 

One gramme 1.0 

One kilogramme 1000.0 



/^ of a grain 
i of a grain 
1§ grains 
15| grains 



gm. = 
gm. = 
gm. = 

(in prescriptions 15 grains) 
gms. = 32 ounces or 2| pounds 



Capacity 

One cubic centimeter, 1.0 c.c. = 15 minims 

= 32 ounces or 2 pints (ap- 
proximately one quart) 



One liter, 1000.0 c.c. 



APPROXIMATE EQUIVALENTS OF APOTHECARIES' 

UNITS 

Weight 

One grain = 0.065 gm. (65 milligrammes) 
One dram = 4.0 gm. (4 grammes) 
One ounce = 30.0 gm. (30 grammes) 

Capacity 

One minim = 0.065 c.c. 

One dram = 4.0 c.c. (4 cubic centimeters) 

One ounce = 30.0 c.c. (30 cubic centimeters) 

One pint = 500.0 c.c. (500 cubic centimeters) 

One quart = 1000.0 c.c. (one liter) 



HOUSEHOLD MEASUREMENTS 
To measure the minim (m. i) or 0.065 gm. : 

The minim is not exactly equal to the drop. There are 
many medicine droppers in practical use, from which each 
drop that is expelled, is approximately equal to one minim. 

By a drop is usually meant the drop which falls from the 
mouth of a bottle when it is held horizontally. Two or two 
and a half of such drops, are approximately equal to one 
minim. 



34 MATERIA MEDICA 

TABLE OF HOUSEHOLD EQUIVALENTS 

3i (one dram) or 4.0 gms. ( 4 grammes) = one level tea- 
spoonful 
5ii (two drams) or 8.0 gms. ( 8 grammes) = one level 

dessertspoonful 
5iv (four drams) or 16.0 gms. ( 16 grammes) = one level table- 
half an ounce spoonful 
§viii (eight ounces) or 240.0 c.c. (240 cubic cen- = one tumblerful. 

timeters) 

METHOD OF REDUCING METRIC QUANTITIES TO 
THEIR APOTHECARIES' EQUIVALENTS 

Rule 1. Multiply the metric quantity by 15; which gives the 
number of grains or minims, and reduce the result to its lowest 
terms. 

(Since 1.0 is equal to 15 grains or 15 minims) 

Example: Reduce 1.03 gms. (1 gramme and 3 centi- 
grammes) to the apothecaries' equivalent. 
Since 1.0 = 15 grains 

1.03 = 15 X 1.03 = 15.45 grains 15i%V = 15^ grs. 

Example : Reduce 64.0 gms. to its apothecaries' equivalent. 
Since 1.0 = 15 grains 
64.0 - 64 X 15 = 960 grains 

Since there are 480 grains in one ounce, in 960 grains there are 
960-^480 = 2 ounces, written §ii 

Rule 2. Divide the metric quantity by 0.085 which gives the 
number of grains, and reduce the result to its lowest terms. 

(Since 0.065 gm. = gr. i) 

Example : Reduce 9.75 gms. to its apothecaries' equivalent. 

0.065|9.75 

150 grains = 5iii 

To reduce very small metric quantities (less than 0.065) to 
their apothecaries' equivalents : 

Rule 3. Write the metric quantity as the numerator of a 
fraction, of which the denominator is always 0.065 (65 milli- 
grammes), and reduce the fraction to its lowest terms. The 
result is the fraction of a grain. 



SYSTEMS OF WEIGHTS AND MEASURES 35 

Example: Reduce 0.0004 (4 decimilligrammes) to its 
apothecaries' equivalent. 

Since 0.065 (65 milligrammes) is equal to 1 grain, 
0.0004 (4 decimilligrammes) is equal to 

0.0004 . 
0065" ^^ ^ ^'^^^ ' 

00004 4 1 



00650 650 160 



gram. 



0.0004 (4 decimilligrammes) is equal to -— - grain. 



METHODS OF REDUCING APOTHECARIES' UNITS TO 
THEIR METRIC EQUIVALENTS 

Rule 1. Reduce the quantity to grains and divide the result 
by 15. The result is the number of grammes. 

Since 15 grains = 1.0 gm. (1 gramme) 

Example: Reduce sii (2 drams) to its equivalent metric 
quantity. 

2 drams = 2 x 60 or 120 grains 
120 -T- 15 = 8 
5ii, 2 drams = therefore, 8 grammes 

When larger quantities are dealt with, the following 
method is easier: 

Rule 2. Reduce the quantity to drams and multiply the result 
by 4. 

Since 1 dram = 4.0 (4 grammes) 

Example: Reduce 5v (5 ounces) to its metric equivalent. 

Since 1 dram = 4.0 gms. (4 grammes) 
5 ounces therefore = 160.0 gms. (160 grammes) 

Rule 3. Reduce the quantity to grains and multiply the result 
by 0.065 (65 milligrammes). 

(Since 1 grain = 0.065 gm.) 

Example: Reduce siss (1 dram and a half) to its metric 
equivalent. 



36 MATERIA MEDICA 

One dram and a half = 90 grains 

Since one grain = 0.065 gm., 90 grains will equal 

90 X 0.065 = 5.85 gms. (5 grammes and 85 centigrammes) 

Rule 4. For very large quantities reduce the amount to ounces 
and multiply the result by 30. 

Since one ounce = 30.0 gms. (30 grammes) 

Example : Reduce 40 ounces to its metric equivalent. 

Since one ounce = 30.0 gms. (30 grammes) 
40 ounces = 40 X 30.0 = 1200.0 grammes. 

To reduce fractional apothecaries' quantities to their metric 
equivalents. 

Rule 5. Multiply the fraction by 0.065 (sixty-five milli- 
grammes), and divide the denominator into the numerator. 

The result is the equivalent metric quantity. 

Example : Reduce j^-^ grain to its metric equivalent. 

Since 1 grain = 0.065 gm. (six centigrammes) 

gram = — - x 0.065 = 100 



100 ° 100 0.0006 

— - grain = 0.0006 gm. (six decimilligrammes). 

Example : Reduce gr. 257 to its metric equivalent. 
Since 1 grain = 0.065 gm. 

1 . . 1 X 1 rv r^nr r^rr, |0.065 

;— — gram is equal to -— • X 0.065 = 250 



250 ^ ^ 250 0.00026 

—-grain = 0.00026 gm. (26 centimilligrammes). 



APPROXIMATE EQUIVALENTS OF METRIC DOSES 
COMMONLY ORDERED 

2.0 gms. ( 2 grammes) 

1.0 gm. ( 1 gramme) 

0.6 gm. ( 6 decigrammes) 

0.3 gm. ( 3 decigrammes) 

0.2 gm. ( 2 decigrammes) 

0.1 gm. ( 1 decigramme) 

0.06 gm. ( 6 centigrammes) = 1 grain 

0.03 gm. ( 3 centigrammes) = i grain 



= 30 


grams 


= 15 


grams 


= 10 


grams 


= 5 


grams 


= 3 


grams 


- 11 


grams 



SYSTEMS OF WEIGHTS AND MEASURES 



37 



0.015 gm. 


(15 milligrammes) = 


i 


0.008 gm. 


( 8 milligrammes) = 


1 

8 


0.004 gm. 


[ 4 milligrammes) = 


iV 


0.0032 gm. 


(32 decimilligrammes) = 


2V 


0.0027 gm. 


(27 decimilligrammes) = 


2V 


0.0022 mg. 


(22 decimilligrammes) = 


aV 


0.0016 gm. 


[16 decimilligrammes) = 


A 


0.0013 gm. 


;i3 decimilligrammes) = 


^V 


0.0011 gm. ( 


;il decimilligrammes) = 


A 


0.001 gm. ( 


' 1 milligramme) = 


bV 


0.0006 gm. ( 


6 decimilligrammes) = 


TOT 


0.0005 gm. ( 


5 decimilligrammes) = 


lio 


0.0004 gm. ( 


4 decimilligrammes) = 


1 
T50 


0.0003 gm. ( 


3 decimilligrammes) = 


1 

■joo" 


0.0001 gm. ( 


1 decimilligramme) = 
PROBLEMS 


COT 



gram 
grain 
grain 
grain 
grain 
grain 
grain 
grain 
grain 
grain 
grain 
grain 
grain 
grain 
grain 



Reduce the following quantities to their apothecaries^ 
equivalents. 
24.06 gms. 11.0575 gms. 0.0055 gm. 0.0425 gm. 0.000275 gm. 

Reduce the following quantities to their metric equiva- 
lents : 

5iii and grs. xlii, Sviii, gigrs.xx, giii and grs.vi, gr.jV, 

gr. 1^0, gr. -2 15, 
How would you measure the following quantities with 
household utensils ? 

3ii|, grs. XV, Oiii i, 6.0 gm., 650.0 c.c, 15.0 c.c. 



CHAPTER III 

SOLUTIONS 

A solution is a liquid containing particles of a solid, gas 
or another liquid, so finely divided, that this dissolved sub- 
stance cannot be seen, and the resulting fluid seems to be of 
one color and consistency. 

In this chapter we shall deal only with the methods of 
calculation and the technique of preparation of solutions. 
We shall leave the discussion of the chemical properties of 
solutions, or the way in which substances behave when dis- 
solved, to the chapter on the administration of medicines, 
where many of tnese properties have a definite bearing. 
In order to understand the subject of solutions the nurse 
should have a clear conception of some of the following 
fundamental facts : 

SOLUTE AND SOLVENT 

1. The dissolved substance is called the solute. 

2. The fluid in which a substance is dissolved is called 
the solvent. 

Theoretically it is possible to dissolve any substance in any 
fluid. Practically, however, some substances dissolve so 
little in some fluids that we speak of them as being insoluble 
in these fluids. 

The solvent may be any fluid: water, alcohol, ether, etc. 
The solution is frequently called by the name of the 
solvent, such as an alcoholic solution, ethereal solution, etc. 
In pharmacy certain definite names are given to substances 
dissolved in certain fluids, such as tincture, fluidextract, etc. 
(See preparations, page 4). 

THE STRENGTH OF THE. SOLUTION 

The strength of the solution is the amount of dissolved 
substance which a given quantity of fluid contains; or the 

38 



SOLUTIONS 



39 



ratio of solute to solvent. It is customary to speak of the 
strengths of solutions in the following ways: 

1. The percentage method 

2. The ratio method 

3. The grains to the ounce method 



Percentage Method 

In this method w^e speak of the quantity of dissolved sub= 
stance (solute), which is contained in 100 parts of fluid (sol- 
vent); the solvent is, therefore, always constant. For ex- 
ample, by a 5% silver nitrate solution we mean that 5.0 gms. 
of silver nitrate are dissolved in 100 c.c. of water. 




==:::- Solvent 96 parts 



^^^rrTs zTT ittf ^ Cocaine (solute) 4 parts 



Total ^ 

■ Quantity 
100 parts 



Percentage Strength 

* Diagram showing the proportion of solute and solvent in a 4% solution of 
cocaine 

To determine the percentage strength of a solution: 

Rule : Divide the quantity of solute used by the total quantity 

of solution made up and multiply the result by 100. 

Example: What is the percentage strength of a solution 
that contains 2.0 gms. of boric acid in 50.0 c.c? 

The quantity of solute is 2,0 gms. 

The total quantity of the solution is 50.0 c.c. 

Dividing 2.0 by 50.0 = 0.04 

Multiplying 0.04 by 100 = 4% 

* The reader should remember that solutions are homogenous (of one color 
and consistency). There is no level separating the solute from the solvent. 
The level of the solute in this, as in all the following figures is purely diagram- 
matic; for purposes of illustration. 



40 



MATERIA MEDICA 



Ratio Method 

In this method we speak of the quantity of fluid (solvent), 
in which one part of the drug (solute) is dissolved. The quan- 
tity of solute is therefore always constant (one part). For 
example, a 1 to 500 solution means that 1 part of solute is con- 
tained in 500 parts of water, 1 gm. in 500 c.c. or 5i in 500 



^P 


f^^ 


w^ ,.? 


J- f 


^~. ^JZ!?V 


i^~i 






t^ ' 






^^^^i^S^ 



Solvent 4 parts 



Total 
Quantity 
5 parts 



Silver nitrate (solute) 1 part 

Ratio Strength 

Diagram showing the proportion of solute and solvent in a 1 :5 sUver nitrate 
solution 

drams. A 1 to 2,000 solution means that 1 part of solute is 
dissolved in 2,000 parts of water. A 1 to 30 solution means 
1 part of substance is dissolved in 30 parts of water, etc. 

To determine the ratio strength of a solution. 

Since the first term of the ratio is always 1 , it is only nec- 
essary to determine the second term of the ratio. 

Rule: To determine the second term of the ratio strength, 
divide the total quantity of solution made up, by the quantity of 
solute used. 

Example: What is the ratio strength of a solution of 
bichloride of mercury made by dissolving a 0.6 gm. tablet in 
300 c.c. of water? 

The total quantity of solution made up is 300 c.c. 
The quantity of solute is 0.6 gm. 

Dividing 300 by 0.6 we get 500, which is the second term of the 
ratio. 

Since the first term is 1, the strength of the solution is 1 : 500. 



SOLUTIONS 41 

Grains to the Ounce Method: This method is gradually 
being abandoned and consists of expressing the number of 
grains of drug dissolved in an ounce of fluid. Like the per- 
centage method the amount of solvent is thus always con- 
stant. 

Method of Changing Percentage Strengths to Equivalent 
Ratios : 

For purposes of calculating solutions it is not essen- 
tial to change the percentage to the ratio strength, be- 
cause any percentage strength may be expressed as a 
ratio; thus 5% is 5:100, 2% is 2:100, etc. 

A percentage strength may be changed to its equivalent 
ratio, however, in the following way: 

Since in the ratio strength the dissolved substance (solute) 
is always 1, we have only to determine the quantity of fluid 
or solvent, in which one part of the drug is dissolved or the 
second term of the ratio. 

Rule: Divide 100 by the percentage strength. This gives the 
second term of the ratio ; the first term is always 1. 

We thus determine the solvent of the ratio strength, which 
is the second term of the ratio. 

Example : Change 2% to its equivalent ratio strength. 
The solute in the percentage strength is 2. 2| 100 

"50" 
Expressing this as the second term of the ratio we have 1:50. 

Method of Changing Ratio Strengths to Equivalent Per- 
centages. 

Rule : Divide the first term of the ratio by the second, and 
multiply the result by 100. This gives the percentage strength. 

We thus divide the dissolved drug (solute), by the fluid in 
which it is contained (solvent). 

Example : Express a 1 : 5000 solution of bichloride of mer- 
cury in its equivalent percentage strength. 

The quantity of solvent in this example is 5000. 
This contains 1 part of drug. 
Dividing 1 by 5000 we get 9.0002. 
Multiplying the result by 100 we get 0.02%. 



42 MATERIA MEDICA 

SATURATION 

It is' not possible to dissolve any quantity of a drug in any 
fluid. A solution which contains as much of a solid, gas, or 
another fluid as it can possibly dissolve, is called a saturated 
solution. When more of the same substance is added to such 
a solution it does not dissolve, but falls to the bottom as a 
sediment, if it is heavier than the solvent, or rises to the top 
if it is hghter. The largest quantity of any substance which a 
fluid will dissolve is called the saturation point of that sub- 
stance. Thus the largest quantit}^ of sodium bicarbonate 
which can be dissolved in 100 c.c. of water is 8.0 gms.; its 
saturation point is therefore 8%. 

The saturation point of all substances is not the same. 
Thus the saturation point of potassium chlorate is 6%; of 
silver nitrate 65%, etc. The saturation point also varies 
with the fluid in which the substance is dissolved. Thus the 
saturation point of quinine bisulphate in water is 10%, in 
alcohol it is 5%, etc. 

Preparation of a Saturated Solution 

A saturated solution may be prepared by finding the 
saturation point of the substance required, from the tables on 
pages 43 and 44, and preparing such a solution in the usual 
manner. The nurse may prepare such a solution, however, 
by merely adding the desired substance to the fluid until it 
no longer dissolves but forms a sediment. The fluid is then a 
saturated solution of the dissolved substance. 

SUPERSATURATION 

When a saturated solution of any substance is heated, it is 
able to dissolve more of the same substance. A solution 
which contains the largest quantity of a substance that it can 
dissolve when the fluid is heated is called a supersaturated 
solution. The largest quantity of a substance which may be 
dissolved in a boiling fluid is therefore called its super- 
saturation point. For example, the saturation point of 
magnesium sulphate in cold water is 54c%, in boiling water it 
is 88%. 



SOLUTIONS 



43 



TABLE OF SATURATION POINTS OF COMMONLY USED 
SOLUTIONS FOR LOCAL USE 



Name of Solution 



Alum 

Benzoic Acid 

Bichloride of Mercury 

Boric Acid 

Carbolic Acid 

Cocaine 

Cocaine Hydrochloride 

Gallic Acid 

Lead Acetate 

Potassium Bicarbonate 

Potassium Carbonate . , 
Potassium Chlorate. . . . 

Potassium Permanganate 

Silver Nitrate 

Sodium Borate 

Sodium Bicarbonate^ 

Sodium Carbonate . . 
Sodium Chloride. . . . 
Tannic Acid 

Zinc Sulphate 



Sat. Point 


Sat. Point 


Sat. Point 


in 


in boiling 


in 


Water 


Water 


Alcohol 


10% 


80% 


insoluble 


0.4% 


6% 


30% 


7% 


33% 


25% 


5% 


25% 


7% 


8% 


All pro- 


All pro- 




portions 


portions 


0.2% 


Decom- 
posed 


17% 


70% 


Decom- 
posed 


40% 


1% 


25% 


20% 


30% 


50% 


3% 


25% 


Decom- 
posed 


insoluble 


50% 


70% 


insoluble 


6% 


40% 


slightly 
soluble 


6% 


25% 


Decom- 
posed 


65% 


90% 


4% 


5% 


66% 


insoluble 


8% 


Decom- 
posed 


insoluble 


25% 


35% 


insoluble 


26% 


30% 


insoluble 


75% 


very solu- 
ble 


30% 


65% 


83% 


insoluble 



Sat. Point 

in 
Glycerin 

freely 
when warm 

'7% 
20% 

All pro- 
portions 



8% 



50% 



1 It may be noted that sodium bicarbonate is decomposed by boiling, which 
occurs in solutions of any strength. This should be remembered in preparing 
sterile sodium bicarbonate solutions for intravenous use. The solution can- 
not therefore be sterilized after it is prepared. The powder itself may be 
sterilized by dry heat of a low temperature and dissolved in sterile water when 
needed. 



44 



MA.TERIA MEDICA 



TABLE OF SATURATION POINTS OF COMMONLY USED 
SOLUTIONS FOR INTERNAL ADMINISTRATION 



Name of Solution 

Ammonium Carbonate . . 

Ammonium Chloride . . . 
Ammonium Bromide . . . 

Ammonium Iodide 

Calcium Oxide 

Hydriodic Acid 

Lithium Bromide 

Magnesium Sulphate . . . 

Methyl Salicylate 

Potassium Acetate 

Potassium Bicarbonate. 

Potassium Bitartarate . . 
Potassium Bromide. . . . 

Potassium Citrate 

Potassium Iodide 

Potassium and Sodium 

Tartarate 

Quinine Bisulphate 

Quinine Hydrochloride. . 

Quinine Salicylate 

Quinine Sulphate 

Salicylic Acid 

Sodium Acetate 

Sodium Bicarbonate 

Sodium Citrate 



Sat. Sol. 

in 

Water 



20% 

33% 
45% 
62% 
0.1% 
10% 

62% 

54% 
slightly 

71% 

25% 

0.5% 
50% 



'0 

100% 

45% 
10% 

100% 

1% 

0.1% 

0.3% 
50% 

8% 
60% 



Sat. Sol. 


Sat. Sol. 


in boiling 


in 


Water 


Alcohol 


Decom- 




posed 


.... 


50% 


2% 


53% 


7% 


70% 


10% 


0.06% 


insoluble 


All pro- 


All pro- 


portions 


portions 


70% 


very solu- 




ble 


88% 


insoluble 


very 


very 


More solu- 


33% 


ble 




Decom- 


insoluble 


posed 




5% 


slightly 


50% 


0.5% 


very 


slightly 


100% 


8% 


50% 


insoluble 


Decom- 


6% 


posed 




Decom- 


62% 


posed 




Decom- 


8% 


posed 




Decom- 


1% 


posed 




6% 


33% 


All pro- 


4% 


portions 




Decom- 


insoluble 


posed 




71% 


slightly 



SOLUTIONS 



45 



TABLE OF SATURATION POINTS OF COMMONLY 
USED SOLUTIONS FOR INTERNAL ADMINISTRA- 

TIO'N— Continued 





Sat. Sol. 


Sat. Sol. 


Sat. Sol. 


Sat. Sol. 


Name of Solution 


in 


in boiling 


m 


m 




Water 


Water 


Alcohol 


Glycerin 


Sodium Bromide 


50% 


55% 


7% 


. . . • 


Sodium Iodide 


100% 


100% 


25% 


.... 


Sodium Salicylate 


55% 


very solu- 
ble 


15% 




Strontium Bromide 


50% 


70% 


very solu- 
ble 




Sodium Sulphate 


26% 


Decom- 
posed 


insoluble 


soluble 


Sodium Phosphate 


15% 


Decom- 
posed 


insoluble 


.... 



PREPARATION OF SOLUTIONS 

The solutions whicL? the nurse usually has to prepare are 
all used externally or on mucous membranes. They may be 
used as antiseptics in the form of wet dressings^ as gargles, 
douches, enemas, etc. Normal salt solution is the only one 
which may also be given intravenously. 

All the external solutions which the nurse may be called 
upon to prepare may be divided into the following three 
groups : 

(a) Solutions made from tablets. 

(b) Solutions made from powders or crude substances. 

(c) Solutions made from stock solutions. 



SOLUTIONS MADE FROM TABLETS 

Problem: To find the «iuantity of water in which to dissolve 
a tablet of known strength to make up a solution of a desired 
strength. 

Example : In how much water would you hsive to dissolve 
a 0.3 gm. (grs. v) tablet of bichloride of mercury, to make 
up a 1-2000 solution? 

Let X represent the unknown number of cubic centimeters 



13 MATERIA MEDICA 

of water to be used; then the tablet has the same ratio to the 
unknown number of cubic centimeters of water, as 1 is to 
2000; since whatever the quantity of fluid will be, the 0.3 gm. 
or grs. V tablet must be 20V0 part of it. Writing the prob- 
lem in the form of a proportion, we have : 
0.3 : X :: 1 : 2000 
The extremes in this example are 2000 and 0.3 
" means " " " " X and 1 

Since in any proportion, the product of the means is always 
equal to the product of the extremes, 

we find that the number of c.c. or 
X = 0.3 X 2000 = 600. c.c. 
We must dissolve the tablet in about 600 c. c, of water, 
which is approximately one pint. 

Rule 1. Write the problem in the form of a proportion in 
which the stock tablet has the same ratio to the unknown quan- 
tity of water (represented by X) as the ratio of drug to water 
in the desired strength ; thus : 

Strength of tablet: X :: drug: water (in desired strength), X 
being the amount of water to be used. 

(In any proportion the outer numbers are called extremes 
and the inner ones means) . The product of the means of any 
proportion is always equal to the product of the extremes. 

Multiply both means together and both extremes together. 
Since their products are equal an equation is thus formed. By 
dividing the right side of the equation by the left with the ex- 
ception of the X, we determine the value of X, or the quantity 
of water in which the tablet is to be dissolved. 

Any problem can be solved in this manner no matter 
whether the strength of the desired solution is expressed in 
the percentage or ratio method; since in either case the re- 
quired strength may readily be expressed as a ratio. The 
strength of the tablet, however, should always be expressed 
in its metric equivalent. 

Example: In how much water must a gr. vii| tablet of 
bichloride of mercury be dissolved to prepare a 1:5000 
solution? 



SOLUTIONS 



47 



ohen. 



Reduce grs. 7i to its metric equivalent 
Since gr. i = 0.065 gm. 

7| grs. = 7J X 0.065 = 0.5 gm. 
0.5 :X :: 1 : 5000 



therefore, X 



X 5000 = 2500 




or X = 2500 c.c. = 2 Jqts. 



(1000 c.c. = 1 quart) 



SOLUTIONS MADE FROM POWDERS OR CRUDE SUB^ 

STANCES 

Problem: To find the quantity of drug to be used to make 
up a desired quantity of a given strength of solution. 

Rule 2. Write the problem in the form of a proportion in 
which the unknown quantity of powder or other crude substance 
to be used (represented by X) has the same ratio, as the ratio 
of drug to water in the required strength, thus : 

X (the quantity of drug to be used) : the quantity to be made 
up : : the amount of drug : water (in the desired strength) 

By multiplying both extremes together and both means 
together and dividing, the value of X or the quantity to be 
made up is determined. 

This method may be used to prepare solutions from 
powders, from a number of tablets, or from other crude sub- 
stances in pure state. 

Example : How much potassium chlorate would be neces- 
sary to make up one pint of a 4% solution? 

One pint = 500 c.c, 4% = 4:100 
Let X = the amount of drug to be used, then 
X : 500 :: 4 : 100 
* The bottle shows the unknown quantity of fluid represented by the X. 




48 MATERIA MEDICA 

Again, the product of the extremes is equal to the product 
of the means. 

Extremes are. 100 and X 
Means are 4 and 500 
therefore, 100 X = 4 x 500, or 2000 



or X = 20 grammes 



20 granoimes of potassium chlorate must be added to 500 
CO. (1 pint) of water to make up a 4% solution. 

In the above examples, it is unportant to reduce ail the 
quantities to their metric equivalents, as apothecaries' quan- 
tities cannot be multiplied by metric quantities. For ex- 
ample, grains cannot be multiplied by grammes or cubic 
centimeters. 

The problems may be solved in the apothecaries' quan- 
tities if they are reduced to ounces, drams or minims. 

Example: How much boric acid would be necessary to 
make up one quart of a 2% solution? 

1. Reduce all the quantities to the apothecaries' units, 
preferably to grains or minims. 

One quart = 15360 minims 

A 2% solution is approximately 10 grains to the ounce 
(480 grains equals one ounce). A 2% solution is approxi- 
mately 10:500 or 1:50 then 

Let X = the number of grains to be used, then 

X : 15360 ::1 : 50 or 
50 X = 15360 grains 
X = 50 I 15360 

307 grains 
307 grains = 5 drams (since 1 dram = 60 grains) 

When the quantity to be made up is not stated: 
Frequently the nurse is required to prepare a solution from 
a powder or crude substance in which the quantity of solu- 
tion to be made up is not stated. In such instances she 
may use her judgment and prepare a quantity sufficient for 
the particular purpose required. 
* The dish represents the unknown quantity of powder to be determined. 



SOLUTIONS 49 

Example : The physician orders an ear to be irrigated with 
a 3% boric acid solution which the nurse must prepare. She 
will know from experience that about 500 c.c. of such a 
solution will probably be needed. She should then use 500 
c.c. as the quantity to be made up and solve the problem in 
the manner outlined above. 

Or, suppose a 5% solution of sodium of bicarbonate is 
ordered for a gastric lavage, when the quantity of fluid is not 
stated. From experience she will know that for this purpose 
about five or six pints of such a solution will be necessary. 
Consequently she should prepare about 2500 or 3000 c.c. 
of such a solution and solve the problem in the manner out- 
lined above. 

SOLUTIONS MADE FROM STOCK SOLUTIONS 

In hospital practice the nurse frequently has to prepare 
solutions from other stock solutions. . The solutions com- 
monly prepared are usually weaker than the stock solution. 

Stronger solutions from weak ones can only be made by 
adding more crude substance. 

When the quantity of stock solution to be used has been 
determined, it should be measured and poured into the de- 
sired receptacle. This quantity is then subtracted from the 
amount to be made up, which gives the quantity of water 
which must be added, to make up the desired solution. 

Example : How much of a 5% silver nitrate solution must 
be used to make up 30 c.c. or 1 ounce of a 1 to 100 solution? 

The stock silver nitrate solution in this problem is the 5% 
solution. 

If we represent the amount of stock solution to use by X, 
then the quantity to be used has the same ratio to the 
quantity of solution to be made up (in this case 30 c.c.) as 
the ratio of drug to water in the required strength (in this 
case 1 to 100) ; since the 30 c.c. must contain 1 part of silver 
nitrate for every 100 parts of water. 

This example, written in the form of a proportion is: 

X : 30 :: 1 : 100 
This proportion would be true, if the stock solution were 



50 



MATERIA MEDICA 



of full strength or 100%. Since it is only a 5% solution 
and contains only if o of the drug, the amount of stock 
solution is only ilo of X; then the correct proportion is: 
5 



100 



X : 30 :: 1 : 100 



In this proportion the means are 1 and 30, and the ex- 
tremes, tIo X, and 100. 

Since in every proportion, the product of the means is 
always equal to the product of the extremes, then, 

^ X X 100 - 30 X 1 

Dividing both sides of the equation by the figures of the left 
side (except the X), 

(Since, when we divide an equation or proportion by the 
numbers on one side of the equation, these numbers become 
Inverted on the other side; thus 2000 becomes -20V0; too be- 
comes --1-; etc.) 

1 



therefore, X 



X 30 = 6.0 c.c. 



In other words, the stock solution will be | of the required 
solution or 6.0 c.c. 



24.0 c.c. 



6.0 c.c. 




Quantity of water 



^^ «, Quantity of stock 5 % silver 
^^■'^ nitrate solution 



Diagram showing the quantity of 5% silver nitrate solution to use and the 
quantity of water to be added to make up 30 c.c. of a 1 :100 silver nitrate 
solution. 

Problem: To find the quantity of a stock solution of known 
strength to use in making up a weaker solution of a desired 
strength. 



SOLUTIONS 51 

Author's Method 

Rule 3. Multiply the strength of the desked solution expressed 
as a fraction, by the strength of the stock solution also expressed 
as a fraction (but inverted) by the quantity to be made up (pref- 
erably expressed in cc). 

The result is the quantity of stock solution to use. 

Subtract this result from the total quantity to be prepared, 
which gives the quantity of water to be added to make up 
the necessary solution. 

The method may be used whether the desired solution and 
the stock solution are expressed in the percentage or the 
ratio strength. In either case the strength can be readily 
changed to a fraction. For example 1 : 3000 is the same 

as g^; 2% is the same as j^. 

The same method may be used when the quantity of 
solution to be made up is expressed in the apothecaries' 
quantities. It should then be remembered, however, that the 
result will be an apothecaries' quantity. 

Technique of Preparation : Measure the quantity of stock 
solution determined by solving the problem and pour it into 
the bottle or dish in which the solution is to be prepared. 
Add to this the quantity of water determined by subtracting 
the above result from the desired quantity of solution. 

Rationale of the Method 

By multiplying the strength of the desired solution by the 
strength of the stock solution inverted, we are really divid- 
ing the strength of the desired solution by the strength of 
the stock solution. We thus determine what part of the 
desired solution will be stock solution. Since the desired 
solution is always weaker than the stock solution, the 
quantity of stock solution that will have to be used will 
always be a fraction of the total amount of the finished 
solution. By the above process we determine in each 
problem what fraction the stock solution will be of the 
desired solution. By multiplying this fraction by the 



52 MATERIA MEDICA 

quantity to be prepared, we obtain the actual quantity of 
stock solution to use. 

In the above example, in working out the value of X we 
found that the stock solution was i of the amount to be 
prepared. See A, page 50. Multiplying this fraction by the 
number of c.c. to be prepared, which in the above ex- 
ample was 30, we obtained 6.0 c.c. as the quantity to be 
used. 

Practically, however, the division of the strength of the 
required solution by that of the stock solution, and multi- 
plying the result by the quantity to be prepared is facihtated 
and carried out in one step by working the problem accord- 
ing to Rule 3 above. 

In each of the following examples the diagrams show 
what part of the desired solution is stock solution. 

Example: How much of a 5% solution of bichloride of 
mercury will have to be used to make up 1000 c.c. (one 
quart) of a 1-2500 solution? 

The strePxgth of the desired solution is 1 : 2500 
Expressed as a fraction it is ^ 



2500 



5 

The stock solution is 5%; expressed as a fraction it is ztttt: and 

inverted it is — ^— 
5 

The number of cubic centimeters to be made up is 1000, then 



iee 200 200 ^ 



-2560- 5 '^^"^ ^ 25 

25 

The amount of the 5% solution of bichloride of mercury 
to be used, is therefore, 8 c.c. Subtracting this from 1000 we 
get the quantity of water to be added to make up 1000 c.c. of 
a 1 to 2500 solution. 

Example: How much of a solution of silver nitrate, con- 
taining 48 grains to the ounce, must be used to make up 
one pint of a 1 to 1000 solution? 



SOLUTIONS 53 

A solution of silver nitrate, containing 48 grains to the 

48 1 
ounce is the same as 48 grains to 480 grains; or ^gx =io o^^ 

10 1 
a ten per cent solution, or jqq or Jq. 

1 pint = 500 CO. 

The solution to be made up, is a 1 to 1000; written as a fraction 
1 



It IS 



1000 



The stock solution is a 10% solution, or 1 to 10, written as a 
fraction it is — and inverted, it is — 

then X -z- X 506* = the amount of stock solution to use 

iUUU -«• 

2 

The amount of the stock silver nitrate solution to use, is 
therefore 5.0 c.c. Subtracting this from 500, we get the 
quantity of water to be added. 

Example: How much of a 1 to 1000 potassium perman- 
ganate solution will have to be used in making up five pints 
of a 1-3000 solution? 

The desired solution is 



3000 



The stock solution is zttt^, inverted — — = ——- 
5 pints = 2500 c.c. (since 1 pint = 500.0 c.c.) 

then^X^x2500 = X 

OUUT-T 1 

3 

X = ?^ = 833i c.c. 

Subtract this from 2500 c.c. (5 pints) to get the quantity 
of water to be added. 



54 



MATERIA MEDICA 



Pour the 833 c.c. of the stock solution into the receptacle 
and add the necessary quantity of water. 



1667 



Diagram showing the 
quantity of a 1:1000 
potassium permanga- 
nate to use and the 
quantit}'' of water to be 
added to make up 5 
pints of a 1 :3000 solu- 
tion. 



C.c. 



SSS.'c.c. 




— Quantity of water 



Quantity of. ptock 
solution 



Example : How much of a 5% bichloride of mercury solu- 
tion must be used to prepare oxx of a 1 : 2000 solution? 
The desired solution is 1 : 2000, expressed as a fraction it is 
1 

2000* 

The stock solution is a 5% solution, expressed as a fraction 

. , . 5 , . ,, ... 100 

it IS — — , and niverted it is — -. 
100 5 

The required quantity is §xx 

According to the lule, 

1 .. i^e 



-9000-^ 5 

-29- 



5 



We therefore have to use § I or oi and m. xxxvi of the stock 
solution. 

Subtracting this from gxx we get the quantity of water to 
be added. 



Diagram showing the 
quantity of 5% bichlo- 
ride of mercury to use 
and quantitj'' of water 
to be added, to make 
up 5 XX of a 1:2000 
solution. 



O XIX 




Quantity of water 
(solvent) 



Quantity of stock 
solution (solute) 



SOLUTIONS 53 

When the quantity to be made up is not stated: 

When the quantity of a desired solution to be made up 
from a stock solution is not stated, the nurse may use her 
judgment and prepare a quantity needed for the purpose for 
which the solution is to be used. She may then solve the 
problem in the manner outlined above, using this quantity 
as the quantity to be made up. 

Problem: To make up a definite quantity of stock solution 
from stock tablets of a definite strength. 

The method of Rule 3 may also be used to determine the 
number of tablets needed to make up a definite quantity of 
solution from stock tablets of a definite strength. When 
solving the problem, however, we use the strength of the tab- 
let expressed as a fraction, instead of the strength of the stock 
solution. The result will be the number of tablets to be used. 

Example: How many tablets of novocaine gr. J must be 
used to prepare 100 c.c, of a 1% solution? 

The solution required is 1%. 

The stock tablets are gr. J. The quantity to be prepared is 
100 c.c. or 1500 minims. 

According to the rule — — X - X 1500 = 60. 

Sixty gr. ^ tablets when dissolved in 100 c.c. of water make a 
1% solution. 

SUMMARY OF SOLUTIONS 

The difficulty of working problems in solutions may be 
readily overcome if the nurse will work out each problem in a 
systematic manner. Before solving any problem she should 
determine the following points : 

1. Is the problem one in which she is to determine the 
quantity of water in which to dissolve a given tablet? Such 
problems should be worked out according to Rule 1, page 46. 

2. Is the solution to be prepared from a powder, a salt 
or other crude substance? Such problems may be solved by 
Rule 2, page 47. 

3. Is the problem one in which it is required to prepare a 
definite quantity of a weaker solution from a stronger stock 
solution? These problems should be solved according to 
Rule 3, page 51. 



56 



MATERIA MEDICA 



When the group to which the problem belongs has been 
determined, the problem should be solved according to the 
appropriate rule, preferably with pencil and paper. 

Finally, it must be remembered that one can only become 
expert in the solving of solution problems by continual prac- 
tice. 

TABLE OF USUAL STRENGTHS OF COMMONLY USED 
SOLUTIONS FOR EXTERNAL USE 



Name of Solution 

Alcohol 

Aluminium Acetate (Bur- 
row's Solution) Stock sol . 

Aluminium Acetate (Bur- 
row's Solution) for local 
use 

Argyrol 

Boric Acid 

Calcium Hydroxide Solu- 
tion (lime water) 

Carbolic Acid 

CoUargol 

Cocaine Hydrochloride 

Chlorine Water 

Corrosive Sublimate (Bi- 
chloride of Mercury) Stock 
Alcoholic Solution 

Corrosive Sublimate 

(Bichloride of Mercury) 
(for use) 

Creolin 

Cresol 

Eserine Sulphate 

Eserine Salicylate 

Formalin (Stock) Solution. . 

Formalin (for use) 

Holocain 

Hydrogen Peroxide 



Percentage of 
Solution 



(1 



of 



50 to 95% 
2 to 7% 



Vi to 2% 
5 to 25% 

3% 

V5% 

2 to 5% 

4% 
H to 4% 

■ 0.4% 



2% 
0.01 to 0.1% 

-1000 to 1-10000) 

Yi to 2% 

5% 

K to 1% 

y2 to 1% 

40% 
formaldehyde gas 
0.05 to H% 

1 to 2% 

3% 



Quantity to 
Quart 



§ xvi-xxx 
5v-Bii 



5i-v 

5i3/^-viii 

Si 

3ss 

3v-BiJ/^ 
5iM 
5iM 



3v 

grs. ii-xv 



5iM-v 
BiJ^ 

5iM-iiK 
3iM-iiJ^ 



^r. x-5iM 



5ii^f 
5i 



SOLUTIONS 



57 



TABLE OF USUAL STRENGTHS OF COMMONLY USED 
SOLUTIONS FOR EXTERNAL USE 



Name of Solution 

Ichthyol 

Iron Subsulphate (Mon- 
sell's Solution) 

Iron Tersulphate 

Iodoform 

Labbaracque's Solution 
(Solution of Chlorinated 
Soda) 

LugoFs Iodine Solution 

Lysol , 

Naphthol 

Pilocarpine Hydrochloride. . 

Potassium Chlorate 

Potassium Permanganate. . . 

Protargol 

Resorcin 

Sodium Chloride (salt) (Nor- 
mal Solution) 

Sodium Chloride (salt) (Phy- 
siological Solution) 

Silver Nitrate 

Zinc Chloride 

Zinc Sulphate 



Percentage of 


Quantity to 


Solution 




Quart 


5 to 


50% 


Si3^-xvi 




13% 


Biv 




10% 


5iii 


5 to 


10% 


§i3^-iii 




2y2% 


5vi 




5% 


niy2 


V2 to 


3% 


5i-Si 


1 to 


50% 


5ii3^-xvi 


M to 


2% 


3iM-v 


2 to 


5% 


3V-5 iK 


1 to 


5% 


5iiK-§ 1^2 


Vz to 


10% 


3iM-iii 




25% 


§viii 




0.9% 


3ii 




0.6% 


5iM 


1 to 


20% 


5ii3^-vi 


1 to 


2% 


3iiH-v 




M% 


grs. XXV 



PROBLEMS 

Strengths 
Express the percentage strength of the following solutions : 

1. 150.0 c.c. of solution containing a 0.3 gm. tablet of bichloride 
of mercury. 

2. 500.0 c.c. of solution containing 0.6 gm. of potassium per- 
iTianganate. 

3. 30.0 c.c. of solution containing 0.5 gm. of boric acid. 

4. One quart of solution containing 5ii of alcohol. 

5. One pint containing 3i| of carbolic acid. 



58 MATERIA MEDICA 

Express the ratio strength of the following solutions; 

1. 500 c.c. of solution containing 10,0 gms. of boric acid. 

2. 3000 c.c. containing 0.25 gm. of silver nitrate. 

3. 5 pints of solution containing two gr. viiss tablets of bi- 
chloride of mercury. 

4. One pint of solution containing 5vi and grs. xv of silver 
nitrate. 

5. §x of solution containing 5v of carbolic acid. 

Express the following percentages in ratios: 4%, 0.6%, 0.9%, 
8%, 20%. 

Express the following ratio strengths in percentage : 1 : 30, 
1 : 2500, 1 : 60, 1 : 5000, 1 : 75. 

Solutions from Tablets 

In each of the following problems determine the quantity of 
water to be used: 

1. To prepare a 1 : 8000 solution from a 0.2 gm. tablet of 
bichloride of mercury. 

2. To prepare a 1 : 12000 solution from a gr. viiss tablet of 
corrosive sublimate. How would you measure and prepare such 
a solution in a home? 

3. To prepare a J% solution from a 0.3 gm. tablet of potas- 
sium permanganate. 

4. To prepare a |% solution of novocaine from tablets of gr. i. 

5. To prepare a 1 to 2500 solution of mercury oxycyanide 
from a 0.1 gm. tablet. 

6. To prepare a 1 to 20 solution of sodium bicarbonate from a 
tablet of gr. v. 

7. To prepare a |% solution of mercury oxycyanide from a 
tablet of 0.5 gm. 

8. To prepare a 5% solution of corrosive sublimate from a 
tablet of 0.1 gm. 

9. To prepare a solution of bichloride of mercury containing 
gr. V to the §1 from tablets of gr. iii. 

10. To prepare a bichloride of mercury solution gr. i to the 
quart from tablets of 0.1 gm. 

Solutions from Powders and Crude Substances 

In each of the following problems determine the quantity of 
powder or crude substance to be used: 

1. To prepare two quarts of a 2% boric acid solution. 



SOLUTIONS 59 

2. To prepare one quart of a saturated solution of sodium 
bicarbonate. 

3. The quantity of salt needed to prepare one quart and a half 
of physiological salt solution. 

4. The quantity of salt needed to prepare enough normal salt 
solution for two intravenous infusions. 

5. To prepare 1 pint of a i% creolin solution. 

6. To prepare one gallon of a 2% carbolic acid solution. 

7. To prepare 8 ounces of a 25% glycerine solution. 

8. To prepare a saturated solution of sodium bicarbonate for 
an ear irrigation. 

9. To prepare a 5% sodium bicarbonate solution for washing 
out the stomach. 

10. To prepare a saturated boric acid solution for an ear 
irrigation. 

From Stock Solutions 

In each of the following problems determine the quantity of 
stock solution to be used: 

1. To prepare 2500 c.c. of a 1 : 8000 solution of bichloride 
of mercury from a 5% solution. 

2. To prepare 1000 c.c. of a 1 to 5000 solution of bichloride of 
mercury from a 1 to 30 solution. 

3. To prepare 1 gallon of a 2% solution of creolin from a 1 : 4 
solution. 

4. To prepare 1000 c.c. of a 1 : 500 Burow's solution from 
a 2% solution. 

5. To prepare one quart of a 1 : 10000 silver nitrate solution 
from a J% solution. 

6. To prepare 15 ounces of a 2% carbolic acid solution from a 
50% solution. 

7. To prepare 500 c.c. of a |% solution of formalin from a 40% 
solution. 

8. To prepare enough of a 1 : 5000 solution of mercury oxy- 
cyanide from a 2% solution for a bladder irrigation. 

9. How many tablets of cocaine hydrochloride gr. | should 
be used to prepare 4 ounces of a J% solution? 

10. How many tablets of morphine sulphate gr. J should be 
used to prepare 60 c.c. of a Magendie's solution? 



60 MATERIA MEDICA 

Miscellaneous 

In each of the following problems determine the rule to be 
applied and work out the problem accordingly: 

1. In how much water should a gr. v bichloride of mercury 
tablet be dissolved to prepare a 0.05% solution. 

2. How many tablets of cocaine hydrochloride gr. | should 
be used to make S ii of a 1 : 50 solution ? 

3. How much sodium bicarbonate should be used to prepare 
a sufficient quantity of a 5% solution for five wet dressings for a 
wound of the hand ? 

4. How much of a 3% solution should be used to prepare 
1500 c.c. of a 1: 10000 silver nitrate solution ? 

5. How much phenol should be used to prepare 30 c.c. of a 
k% solution ? 



CHAPTER IV 

THE PREPARATION OF DOSES 

All drugs are poisons — they are harmful to the body. In 
fact some of them may even cause death if given in sufficiently 
large quantities. They injure the body by making one or 
more organs excessively active (overstimulation), by lessen- 
ing activity to a very marked degree (excessive depression), 
or by destruction of the cells (irritation). 

We take advantage of these changes which drugs cause in 
the activity of organs or tissues and utilize the drugs in 
the treatment of disease to produce desired effects. 

Beneficial and poisonous effects differ only in degree and 
depend upon the size of the dose given. Thus a small 
quantity of a substance will produce beneficial effects while a 
larger one may cause poisonous effects. 

DOSAGE 

By experiments on animals we can determine the smallest 
quantity of a drug that must be given to produce any change 
in the activity of an organ or tissue of the body. This is the 
smallest or minimum dose. By similar experiments we can 
determine the largest quantity of the same drug which may 
be given without causing dangerous effects. This is the 
maximum dose. A quantity of a drug which exceeds this 
maximum dose is called an overdose or poisonous dose. 
Such doses may cause dangerous or poisonous symptoms. 
All drugs have different doses; if several substances happen 
to have the same dose it is merely a coincidence. 

Rule for Dosage 

There is no rule whereby the doses of all drugs may be 
remembered. The dose of each drug must be memorized. 
The following rule, however, will facilitate the remembering 

61 



62 MATERIA MEDICA 

of the principal preparations of the common potent drugs 
such as opium, nux vomica, belladonna, digitahs, etc. 

The dose of the crude drug is gr. i or 0.065 gm. 

Fluidextracts represent 100% of drug, therefore the dose is 
the same as the crude drug, but in fluid measure: m. i or 
0.065 gm. 

Tinctures are 10% solutions; they are to as strong as the 
drug, therefore the dose is 10 times that of the crude drug but 
in fluid measure ; of the potent drugs it is usually m. x or 0.6 c.c. 

Extracts are concentrated solid preparations which are 
about 4 times as strong as the crude drug ; therefore the dose 
is i as much as the crude drug; of the potent drugs it is usually 
gr. i or 0.015 gm. 

Conditions Influencing the Dose 

Age : An older person usually requires a larger dose than a 
younger one. Old people and children, however, require 
smaller doses. 

Sex: Males usually require larger doses than females. 

Weight: Heavier, stouter individuals usually require larger 
doses than hghter ones. 

Temporary conditions: After a meal more absorption usually 
takes place, therefore the effects are usually more marked. 

Time of Administration: Some substances produce better 
effects at different times. Thus drugs which produce sleep 
cause Httle effect in the morning and a better effect at night. 

Pregnancy : In pregnancy potent remedies should be given 
in the smallest quantities; since they are apt to cause abor- 
tion. 

Lactation: In the nursing woman care must be exercised 
in the doses of many remedies which are ehminated in the 
milk and which may therefore induce poisonous symptoms 
in the nursing child. 

CALCULATION OF DOSES 

Potent drugs usually come in the form of tablets of definite 
doses for hypodermic use. They are frequently put up com- 
bined with various other drugs with which they are com- 



THE PREPARATION OF DOSES 63 

monly given. In hospital practice, for reasons of economy^ 
potent substances are often kept in solutions of various 
strengths. Frequently, however, a dose may be ordered 
other than that of the usual tablets, or, the nurse may be 
called upon to give a dose that she cannot readily meas- 
ure from the solution in stock. In such instances she will 
have to calculate the dose required either from the tablets 
of the usual dose or from a stock solution of a definite 
strength. 

CALCULATION OF DOSES FROM TABLETS 

Problem : To give a fractional dose from a tablet of a definite 
strength. 

When a dose of a drug is ordered for hypodermic or inter- 
nal use other than the usual strengths of tablets in stock, the 
following method will enable the nurse to calculate and 
prepare the correct dose : 

Rule 1. Divide the required dose by the strength of the stock 
tablet. This gives the fraction of the tablet to be given. 

Technique: Dissolve the stock tablet in a quantity of water 
in which the denominator of this fraction can be divided evenly. 
Give the patient this fraction of the quantity of water in which 
the tablet has been dissolved. 

If the answer is more than 1 and a whole number, then the 
number of tablets indicated by this number should be given. 

If the answer is a whole number and a fraction, dissolve 
one tablet in a quantity of water in which the denominator of 
the fraction can be divided evenly. Take the fraction of that 
amount of water and add to it the number of tablets indicated 
by the whole number. 

Example 1 : How would you prepare strychnine sulphate 

gr. — from tablets of gr. ^? 
According to the rule: 

60 ' 
We therefore have to give J of the gr. ^^ tablet. By dissolv- 



60 ' 30 60 1 60 2 



G4 MATERIA MEDICA 

ing this tablet in m. xx of water (into which 2 can be divided 
evenly) and giving the patient | of that or m. x, we will give the 
correct dose. 

Example 2. How would you give gr. ilo of atropine 
sulphate from tablets of gr. iJo? 

The required dose is gr. j^q, the stock dose is gr. j J-q- Accord- 

. , ,, , 1.1 1 ^ 100 5 

mg to the mle, _-^_ = _x — ==g. 

We therefore have to give f of the gr. li q- tablet. 

Since 6 can be divided evenly in m. xxx of sterile water, we 
dissolve the gr. y^o" tablet in that number of minims of water, and 
give the patient | of it or m. xxv. 

Example 3. How would you give gr. 3V of strychnine sul- 
phate from tablets of gr. 5V? 

The required dose is gr. -gV, the dose in stock is gr. ^V 

According to the rule, '^-^7^=7;7,X--- = ~=li tablets. 
6{) oO oU 1 oil 

Since 3 (the denominator of §) can be divided evenly into 30, 

we dissolve 1 tablet in m. xxx of water and take | of that or 

m. XX. To this we add another tablet of gr. ^V- 

Problem: To prepare a necessary number of doses from one 
or more tablets of another dose. 

The nurse is occasionally called upon to prepare a number 
of doses from one or more tablets of another dose. The fol- 
lowing method will enable her to prepare the necessary quan- 
tity and to administer accurate doses from this quantity. 

Rule : Divide the total quantity of the tablets in stock by the 
dose to be administered. 

The result will be the number of c.c. in which the tablet should 
be dissolved. 

Technique: To administer the correct dose give 1.0 c.c. (m. xv) 
of this quantity each time. 

The tablet may also be dissolved in a number of minims 
indicated by the result, of which m. i. is given each time. 
This method is not as good since it necessitates working with 
smaller quantities. 

Example : The doctor orders the patient to get strychnine 
sulphate gr. §00 every two hours. The nurse has only one 



THE PREPARATION OF DOSES 65 

tablet of gr. ^V- How many doses can she prepare from the 
tablet and how should she prepare an accurate dose each 
time? 

There are as many doses as -g^o- is contained into bV 

A J- X .1, 1 1 . 1 1 300 300 ,^ 

According to the rule, _ ^ _ = ^-^ x — = -3^ = 10 

The tablet should then be dissolved in 10 c.c. of water thus 
preparing 10 doses. 1.0 c.c (m. xv) should be given every two 
hours, since every 1.0 c.c. contains gr. 3^0^. 

CALCULATION OF DOSES FROM STOCK SOLUTIONS 

In many institutions, for reasons of economy, many potent 
drugs which are used hypodermicall}^ are kept in solutions of 
various strengths. As a general rule, the more potent sub- 
stances are kept in weak solutions (1% or less) and the 
less potent ones in stronger solutions. For example, strych- 
nine sulphate is usually kept in 1% solutions and even in 
weaker solutions. Solutions of camphor or caffeine usually 
come in 20% or 25% solutions and even in stronger solutions. 

In the calculation of doses from stock solutions the follow- 
ing facts may be emphasized. They are the elements upon 
which the calculations for such solutions are based. 

1. In the following examples, the drop represents the drop 
obtained from a minim dropper and is therefore equal to 
one minim. 

2. The fraction of a grain contained in one drop of a stock 
solution is always indicated by the percentage or ratio 
strength of the solution expressed in the form of a fraction. 
Thus one drop of a 1% solution contains gr. li^, one drop of a 
2% solution contains gr. tIt) or gr. gV, one drop of a 20% solu- 
tion contains gr. tA or gr. i, one drop of a 1 : 30 solution 
contains gr. t^, etc. 

For practical purposes we may classify all stock solutions 
in two groups: 

(a) Relatively strong solutions. 

(b) Relatively weak solutions. 

The relatively strong solutions usually contain substances 



66 MATERIA MEDICA 

that are administered in rather large doses ; such as camphor, 
given in doses of grs. iii, grs. v, etc., caffeine, given in doses 
of gr. J, gr. i, etc. 

The relatively weak solutions usually contain very potent 
substances that are administered in very small fractional 
doses, strychnine, given in doses of gr. ^\, gr. sV, etc., atro- 
pine, given in doses of gr. j^-^, etc. 

Problem: To calculate the dose to be given from stock solu- 
tions of various strengths. 

This may be done by the following two methods : 

1. The Division Method. 

2. The Least Common Denominator Method. 

Every problem may be solved by either method. Prac- 
tically, however, the division method is more applicable for 
the following problems : 

(a) Calculation of large doses such as gr. J, grs. iii, grs. v, 
etc. 

(b) Calculation of doses from solutions in which a given 
number of minims contain a definite dose; for example, 
when m. x contain gr. sV- 

The least common denominator method is more applicable 
for the calculation of small doses from relatively weak solu- 
tions, for example gr. li^, gr. il^, etc. For the calculation 
of such problems the advantage of this method is that it 
avoids working with fractions of a drop or fractions of a 
minim. 

THE DIVISION METHOD 

Rule: Divide the dose required by the fraction of a grain 
contained in one drop or minim of the stock solution. The 
result is the number of minims of stock solution to use. 

Technique 

(1) Pour the number of minims indicated by the result into 
a medicine spoon. 

(2) Add enough sterile water to fill up a hypodermic syringe 
and give the dose to the patient. 



THE PREPARATION OF DOSES 67 

Example: To give strychnine sulphate gr. 2^^ from a 1% 
solution. 

Since the stock solution is a 1% solution each drop will 
contain gr. tJq-. 

According to the rule, 25-100 = 25^T- = ^==^ 

We therefore give 4 minims or drops of the 1% solution 
which contain gr. -i^. 

Example : To give gr. ^^5 of strychnine sulphate from a so- 
lution of which m. X = gr. 3V 

Since m. x = gr. — , each drop or 

oU 

m. i, will contain 5^ of ^ or gr. A 

If each drop contains gr. ^i-Q, gr. 2^5 will be contained in as 
many drops as 3^ is contained in i^ or, 

A ^- + +u 1 1 . 1 1 300 300 ,0 

According to the rule, -^^ = _x-^ = ^ = 12 

We therefore would have to give m. xii of the stock solution 
which contain gr. -f^. 

Example : To give grs. iv of caffeine sodium benzoate from 
a 25% solution. 

Each drop of a 25% solution contains gr. iVo ? or gr. J of 
caffeine sodium benzoate. 

To give grs. iv therefore, we would have to give as many 
minims as i is contained in 4, or, 

1 4 

According to the rule, 4-r-- = 4x- = 16 

To administer a dose of grs. iv of caffeine sodium benzoate 
we would give then, m. xvi of the 25% solution. 



68 MATERIA MEDICA 



THE LEAST COMMON DENOMINATOR METHOD 

(Author's Method; 

The method may be illustrated by the followmg concrete 
example : 

To give atropine sulphate gr. 3^0 from a 1% solution. 

Every drop or minim of a 1% solution contains gr. li^. 
According to the method of division, dividing 3^0 by 1^0- 
we get -3-. We therefore have to give | of a minim. We 
cannot obtain, however, the gr. 3 0^0 in an even number of 
minims of the stock solution. We must then prepare another 
solution from which an even number of minims will contain 
the gr. ^^0. This may be done by taking one drop of the 1% 
solution and adding two drops of water to it ; thus diluting it 
twice. Each drop of such a solution will contain gr. 3^0^, 
consequently we take one minim of this solution for the 
desired dose. 

By th(^ least common denominator method we may deter- 
mine in each problem the number of times a quantity of the 
stock solution is to be diluted. From this new diluted solu- 
tion we can obtain the required dose in an even number of 
minims. 

Rule 

1. Reduce the smallest fraction of a grain contained in one 
minim or drop of the stock solution, and the dose to be given, 
to fractions with a least common denominator. 

To Find the Dilution 

2. Subtract the numerator of the fraction of a grain contained 
in a minim of the stock solution from the numerator of its equiva- 
lent fraction. 

Add this number of minims of sterile water to one drop of the 
stock solution. 

To Find the Number of Minims of the New Diluted Solution to Use 

3. Of this new diluted solution give the number of minims 
indicated by the numerator of the least common denominator 
fraction formed from the required dose. 



THE PREPARATION OF DOSES 69 

Technique 

(1) Draw up some stock solution in a minim dropper, and 
pour one drop of it into a medicine spoon. (See illustration, 
Fig. 2.) 

(2) To this drop, add as many drops of sterile water as the 
number of times it is to be diluted, as determined by solving the 
problem. (See illustration, Fig. 3.) 

(3) Draw up some of this diluted solution in a minim dropper, 
and pour the number of drops needed (as determined by solving 
the problem) into another medicine spoon. (See illustration. 
Fig. 4.) 

(4) Add enough sterile water to this quantity to fill up the 
hypodermic syringe, draw the fluid up into the syringe and ad- 
minister the dose. (See illustration, Fig. 5.) 

In giving doses less than that contained in one drop of 
the stock solution we always dilute one drop of the stock 
solution. 

In giving doses greater than that contained in one drop of 
the stock solution w^e dilute more than one drop. (See 
page 72). 

The following examples will illustrate the method : 

Example; To give gr. -^ho of atropine sulphate from a 1% 
solution. 

1. Each drop of the atropine sulphate solution contains gr. yJ-q. 

2. The desired dose is gr. -2^. 

3. The least common denominator of 100 and 200, is 200. 

* A (^ * 
According to the rule, foo "" 200 

200 200 

One drop of the atropine solution must be diluted with 
one drop of water, since (2) - /fy = 1. 

* A encloses the numerator of the fraction of a grain contained in one drop 
of the stock solution. 

O encloses the numerator of the least common denominator fraction formed 
from the fraction of a grain contained in one drop of the stock solution. 

D encloses the numerator of the least common denominator fraction formed 
from the required dose. 



70 MATilJKlA MEDiCA 

(This makes a solution of which each drop contains 
gr. -2^0 .) 

The number of drops of this diluted solution to use, is 

indicated by the numerator of ^~ formed from the desired 

dose, gr. -2^0 ; which is 1. 

We therefore take one drop of the atropine sulphate solu- 
tion, add one drop of w^ater to it, and from this we take one 
drop of the resulting solution. To this drop, add enough 
water to fill up a hypodermic syringe and administer to the 
patient. 

Example : How would you give gr. i i q- of atropine sulphate 
from a 1% solution? 

1. Each drop of the atropine solution contains gr. 1 oq- 

2. The desired dose is gr. ifo 

3. The least common denominator of 100 and 150 is 300 

According to the rule, ^- = ^ 

150 300 
Take one drop of atropine solution, add to that as many 
drops of water as the difference between the nimierator of 
the dose contained in one drop of the stock solution ito^ 
(numerator =^), and its equivalent fraction af^ (numxor- 
ator = (3)) (3) - ^ =2. We therefore add 2 drops of water. 

The numerator of ^ formed from lio, is the number of 

drops of the resulting solution to use. To this we add enough 
sterile water to fill up the hypodermic syringe and administer. 
Example: To give gr. -300 atropine sulphate from a i% 
solution. 

Each drop of i% atropine solution contains gr.^_ =gr.-2-o 0. 

1 G 

The least common denominator is 600. 
According to the rule, ^ = ^ 

300 600 
Then take one drop of the J% atropine solution and add 



METHOD OF PREPARING DOSES OF MEDICINES FROM STOCK 

SOLUTIONS 







m.-M 




■*^% 



Fig. 1. Apparatus necessary for preparing and administering 
stock solutions. 



doses from 




Fig. 2. Measuring the number of minims of stock solution. 




Fig. 3. Adding the necessary number of minims of water, thus forming 
new diluted solution. 




Fig 4. Measuring the necessary number of minims of the new diluted soiution., 







% 


m ^ 


k 




^^ _^. 






if^S^^m 


-ir 





Fig. 5. Drawing up the number of minims to be administered into the hypo- 
dermic syringe. 





Fig. 6. The correct way to give a 

hypodermic injection. 
(Note the direction of the needle.) 



Fig. 7. The wrong way to give a hy- 
podermic injection. 



THE PREPARATION OF DOSES 71 

two drops of water ((D - 2|^ = 2) and take 2 (numerator of 
^, which is the same as 3^0) drops of the resulting solution. 

When the dose to he prepared is larger than that contained in one 
TYiinim of the stock solution. 

In doses larger than that contained in one drop of the 
stock solution^ we find, that after taking one drop of the 
stock solution, and adding the necessary number of drops of 
water, the total quantity made up, is less than the number of 
drops of the resulting solution to use. 

Example: To give gr. tV of strychnine sulphate from a 
1% solution. 

Each drop of a 1% solution contains gr. t^o of strychnine. 
The least common denominator is 300. 

According to the rule, ^"^300 

60 300 

® - 2^ = 2, the number of drops of water to add. 

We would then have to take 1 drop of the stock solution, 
and add 2 drops of water to it. Of this diluted solution 
we then take \h\ drops. But the total number of drops 
of the resulting solution is only 3, while the number to be 
used is 5, more than the total amount. 

The object of taking 1 drop of the stock solution, and 
adding 2 drops of water, is to make up a solution, of which 
each drop shall contain gr. ^^0 of strychnine, and then, in- 
stead of giving gr. tjV of strychnine, we give its equivalent, 
gr. gf 0, or 5 drops of the resulting solution. 

Therefore, as long as we keep the same ratio between the 
stock solution and the quantity of water with which it is to be 
diluted, we will always have a solution of which each drop 
contains gr. ^^o"; no matter how much of such a diluted solu- 
tion we prepare. 

Instead then, of taking only one drop of the strychnine 
stock solution, and adding two drops of water, thus making 
up only three drops of a solution (of which each drop con- 
tains gr. ^^^), we multiply the drop of the stock solution and 



72 MATERIA MEDICA 

the number of drops of water to be added, each by 5, or 10, 
or any number which will make the total quantity of the 
resulting diluted solution more than the number of drops 
to administer. In this way, we make up a larger quantity 
of the same solution, each drop of which contains gT. 3 Jo-- 
In the example given above, if we multiply the number of 
drops of stock solution to use, and the number of drops of 
water to be added, each by 5, we make up 15 drops of a 
solution, each drop of which contains gr. 3 J^ of strychnine. 
5 drops of this solution will contain gr. ^V or gr. ^f^ of 
strychnine. 

When the dose to he prepared is larger than that contained in one 
minim of the stock solution: 

Multiply the one drop of stock solution and the number of 
times it is to be diluted, each by any number which will make 
the total quantity of new diluted solution more than tlie number 
of minims to be given from it. 

Example: To give gr. lio strychnine sulphate from a J% 
solution. 

Each drop of the strychnine solution contains gr. ^^^r of 
strychnine. 

The least common denominator of 200 and 120 = 600. 
According to the rule, ^ "" 600 

120 600 

Take one drop of i% solution of strychnine, add (@ - 
^ = 2) 2 drops of water, and take [S] drops of the resulting 
solution. Since the total quantity of the resulting solution 
is only 3 drops, we multiply the drop of stock solution, and 
the number of drops of water to be added, each by 3. We 
then take 3 drops of the J% solution of strychnine, and 
add to it 6 drops of water. Of this diluted solution we 
give the patient 5 drops. 

Example: To give gr. ^s of atropine sulphate from a 
solution of which m. v = gr. ^V- 

Sincem.v = gr.l, m.i = |of^ = gr. _1_ 



THE PREPARATION OF DOSES 73 

Each minim of the stock solution contains gr. -—- of atropine. 

200 

The least common denominator of 200 and 75 = 600 
According to the rule, ^ = L^ 

75 600 
Take one drop of the atropine solution (stock) and add 
(D ~ ^ =2 drops of water. Take \s] drops of the result- 
ing solution. Since the total amount of the resulting solution 
is less than 8 drops, we multiply the drop of the stock solu- 
tion, and the number of drops of water to be added, each by 4 
(to make up a sufficiently large quantity). We then take 
4 drops of the atropine solution, to which we add 8 drops of 
water. Of this diluted solution we take \s] drops, add 
enough sterile water to fill up a hypodermic syringe and give 
to the patient. 

CALCULATION OF DOSES FOR CHILDREN 

To determine the dose of a drug to be administered to a 
child, Vv^e fill in the known quantities in the following for- 
mula, and then calculate it. The result is the fraction of the 
adult dose to administer. 

Young's Rule : Age of the child, divided by (age + 12) = the 
fraction of the adult dose, or, 

of adult dose. 



age + 12 

For potent drugs, a shghtly smaller quantity should be 
administered, and for some drugs a shghtly larger dose 
should be administered. 

Example: How much aspirin should be given to a child 
3 years old? (Adult dose of aspirin = grs. v.) 

Age of child = 3 

^^^^' 3-f 12 " l5 "" 5 
We therefore give the child I of grs. v or gr. i of aspirin. 



74 MATERIA MEDICA 

SUMMARY OF CALCULATION OF DOSES 

In preparing doses of potent drugs for hypodermic oi 
internal use, the calculation of the problems will be facilitated 
by handling them in the following systematic manner: 

Before solving each problem the nurse should determine: 

1. Whether the dose is to be calculated from a tablet. 

2. Whether the dose is to be calculated from a stock solu- 
tion. 

If the dose is to be calculated from a tr.blet the problem 
should be solved according to Rule 1, page 63. 

If the dose is to be calculated from a stock solution, the 
division method may be used for the following problems: 

(a) Large doses from stock solutions of more than 1%. 

(b) Fractional doses from solutions of which a definite 
number of minims contain a definite dose. 

The least common denominator method may be used for the 
following problems: 

(a) For all doses to be calculated from all relatively weak 
solutions such as 1% solutions or less. 

(b) For calculating fractional doses from solutions of 
which a definite number of minims contain a definite dose. 

It should be remembered, however, that all problems from 
stock solutions may be solved by either method. 

The calculation of doses will lose its terrors if the nurse 
remembers the rules to be apphed in each particular case 
and the reasons underlying them. It must be emphasized, 
however, that one can become expert only by constant prac- 
tice in solving many and varied problems^. 



THE PREPARATION OF DOSES 



75 



TABLE OF USUAL STRENGTHS OF COMMONLY USED 
SOLUTIONS FOR INTERNAL USE 



Name of Solution 



Ammonium Bromide 

Ammonium Iodide 

Aromatic Spirits of Ammonia . . . 

Arsenious Acid Solution 

Caffeine Sodium Benzoate 

Camphor Oil 

Camphor Spirits 

Camphor Water 

Dilute Acetic Acid 

Dilute Hydrochloric Acid 

Dilute Hydrocyanic Acid 

Dilute Nitric Acid , 

Dilute Nitrohj^drochloric Acid . . . 

Dilute Sulphuric Acid 

Diuretin Solution (Theobromine 
Sodium Salicylate) 

Epinephrine Chloride (Adrenalin 
Chloride 

Fowler's Solution of Arsenic (Liq- 
uor Potassii Arsenitis) 

Homatropine Hydrobromide 

Mercury Salicylate 

Morphine Sulphate (Magendie's 
Solution) 

Nitroglycerine solution 

Paregoric (Tinct. Opii. Cam- 
phorata) 

Potassium Iodide Solution (Sat- 
urated) 

Potassium Iodide Solution 

Sodium Bromide 

Sodium Iodide Solution 

Spirits of Chloroform 

Spirits of Ether 

Spirits of Ether (Compound) .... 

Strontium Bromide 



Percentage of 
Solution 



25% 
50% 

4% 
1% 
25% • 
20% 
10% 

0.8% 

6% 
10% 

2% 
10% 
20% 
10% 

,25% 

0.01% (1-1000) 

1% 

2% 

0.02% (1-5000) 

3% 
1% 

0.4% 

100% 

50% 

50% 

50% 

10% 

30% 

30% 

50% 



Quantity 
to Ounce 



511 

3iv 
grs. X 
grs. V 
3 ii 
3iK 
gr. 1 

gr. i^A 
m. XXX 
m. 1 
m. X 
m. i 

SiVs 
m. 1 

5 ii 



gr. Vz 



grs. V 
grs. X 
gr- Vio 

grs. XV 
grs. V 

grs. ii 



5iv 

§^ 
m. I 

5ii3^ 
oiij^ 
5iv 



76 MATERIA MEDICA 

PROBLEMS 
Doses from Tablets 

How would you calculate and prepare the following doses: 

1. Strychnine sulphate gr. 5V from tablets of gr. 3V. 

2. Eserine salicylate gr. 3V from tablets of gr. ^^o • 

3. Atropine sulphate gr. 3V from tablets of gr. t^t- 

4. Atropine sulphate gr. j^-q from tablets of gr. ito". 

5. Atropine sulphate gr. ^V from tablets of gr. iJ-^. 

6. Heroin hydrochloride gr. ^ from tablets of gr. J. 

7. Strj^chnine sulphate gr. -jV from tablets of gr. ^V- 

8. Pilocarpine hydrochloride gr. i from tablets of gr. |. 

9. How many doses of strychnine sulphate gr. -^^-^ can you 
prepare from a tablet of gr. ^V? ^^rid how would you give this dose 
accurately each time? 

10. How many doses of atropine sulphate gr. g-lo" can you 
prepare from two tablets of gr. j^-^, and how would you give an 
accurate dose each time? 

Doses from Stock Solutions 

How would you calculate the required dose from the stock 
solution in each of the following problems: 

1. Caffeine Sodium Benzoate grs. vi from a 25% solution. 

2. Camphor grs. v from a camphor liniment. 

3. Sodium bromide grs. xv from a 25% solution. 

4. Potassium iodide grs. xx from a saturated solution, and 
from a 50% solution. 

5. Morphine sulphate gr. ^ from a 1 : 30 solution. 

6. Strychnine sulphate gr. ^, gr. ^\, gr. ^V; gi"- rio. gr. ai-o; 
gr. YT5 from a 1% solution. 

7. Eserine salicjdate gr. ~, gr. ~ from J% solution. 

8. Strychnine sulphate gr. ~, gr. —, gr. —, from a solution 
of w^hich m. x contain gr. -^q. 

9. Atropine sulphate gr. y~, gr. ~-q, from a J% solution. 

10. Morphine sulphate gr. J, gr. ^, gr. ■—, gr. 2V from Magen- 
die's solution. 

11. Atropine sulphate gr. —q} gi'- tIoj g^'- ^io ^^'^m a solution 
of which m. v contain gr. -3^. 

12. Atropine sulphate gr. ji-Q from a solution of which m. x 
contain gr. xto- 

13. Eserine sulphate gr. -^q, gr. -^q, gr. ~ f^'O^ ^ i% ^0^^" 
lion. 



THE PREPARATION OF DOSES 77 

14. Strychnine sulphate gr. gV, gr. -^V, gr. xio. gr. rio fi"om a 
1 : 300 solution. 

15, Nitroglycerine gr, xk; g^ tfo. g^- tV; gr- 5V from a 1% 
solution. 

Doses for Children 

In each of the following examples, how much of the adult 
dose would you give: 

(1) Caffeine Citrate to a 4 year old child (adult dose is gr. i). 

(2) Morphine Sulphate to a 6 year old child (adult dose is 
gr. i). 

(3) Tincture of Digitalis to a 10 year old child (adult dose is 
m. x). 

(4) Atropine Sulphate to a 2 year old child (adult dose is 

gr* ■6 0"~T2"0"V 

(5) Compound Licorice Powder to a 6 year old child (adult 
dose is 5 i). 

Miscellaneous 

In each of the following problems indicate the methods to be 
used: 

1. How would you give Caffeine Sodium Benzoate gr. ii from 
a 40% solution? 

2. How would you give Atropine sulphate gr. ~ from a J% 
solution? 

3. Eserine salicylate gr. ^^^ from a tablet of gr. ~. 

4. Strychnine sulphate gr. -^q from a solution of which m^ V 
contain gr. — . 

5. Codeine sulphate 0.008 gm. from a 1 : 50 solution. 



CHAPTER V 

THE ADMINISTRATION OF MEDICINES 

The administration of medicines is perhaps the most 
Important branch of Materia Medica for the nurse. The 
physician is usually content merely with ordering remedies 
to be given. The effect of drugs, however, may frequently 
depend upon the method in which they are given, the care 
with which they have been kept and the accuracy with 
which the doses are prepared. 

Even in hospitals, where a relatively ideal condition for 
nursing exists, the methods for the administration of med- 
icines may be based on more or less empiric rules. These 
methods are handed down from nurse to nurse until they 
may assume a local color, which accounts for the variety of 
the methods extant in similar equally efficient institutions. 

In this chapter we shall discuss the methods of adminis- 
tration according to more or less definitely established 
scientific principles insofar as our present knowledge of the 
action of drugs permits us to do so. Before taking up the 
administration of medicines proper, it is important for the 
nurse to have a definite idea of the methods of caring for and 
handhng remedies so as to prevent deterioration, which may 
interfere with the producti n of desired results. She should 
thoroughly familiarize herself with the physical and chem- 
ical properties of the medicines she is using either in the 
ward or when on private duty. She should develop certain 
habits of precision in preparing doses to such an extent that 
they should become her second nature. 

CARE OF MEDICINES 

1. All medicines should be kept in a special medicine 
chest. 

2. It is customary to assign the care of the medicine 

closet to one nurse. The closet should always be kept locked 

78 



THE ADMINISTRATION OF MEDICINES 79 

and the key held by the nurse in charge^ who should see that 
every commonly used substance is always in stoclv. 

4. All bottles, boxes, etc., should be appropriately marked 
with labels which are not apt to fall off. The remedies should 
be arranged in the closet alphabetically in systematic order. 
The following order is suggested : 

(a) Substances used externally should be kept together; 
solids and liquids in separate compartments. 

(b) Substances for internal use should be grouped to- 
gether; solids and liquids in separate compartments. 

(c) Stimulants and all potent remedies such as morphine, 
etc., should be kept in a compartment by themselves, ad- 
jacent to the hypodermic tray, which should always be 
ready for use. 

(d) All poisons should be labeled ''Poison.'^ They should 
be kept in distinctive bottles, such as blue rough bottles, 
and kept together in a separate compartment. 

(e) Oils should be kept in a cool place, since they readily 
decompose. 

5. The nurse in charge of the medicine closet should 
examine the contents of the closet daily. She should order 
whatever is needed in small quantities and examine the 
character of all the medicines. 

6. The change in color, consistency or odor of any sub- 
stance should be reported to the physician or pharmacist 
and if this has interfered with its efficiency a fresh supply 
should be obtained. 

7. Every bottle of medicine should be corked and im« 
mediately replaced after use. 

CARE OF APPARATUS 

1. All apparatus should be kept together. 

3. Weights should be kept clean by dusting, not by polish- 
ing. 

2. Balances should always be kept covered. 

4. Test the balance before use. 

5. For measuring fluids glass utensils should be used. 



80 MATERIA MEDICA 

ACCURACY 

While preparing medicines the nurse should concentrate 
her entire attention upon the work. She should not be dis- 
turbed by other duties. 

1. When calculating doses be sure your answer is correct; 
verify it if in doubt. 

2. Familiarize yourself with the smallest and largest doses 
of the remedies you are giving. If you think the maximum 
dose has been exceeded always verify it. 

3. Always look three times at the label of every bottle or 
box before using any of its contents : when, taking it from the 
closet, when removing the contents, and when returning the 
bottle or box to the medicine closet. 

4. Never use medicines from an unmarked bottle, or when 
you are in doubt as to the nature of the contents. 

5. When pouring fluids, hold the bottle with the label 
pointing upwards so as to avoid soiling it. 

6. Measure the quantities as ordered; do not give a tea- 
spoonful when a dram is ordered and vice versa. Measure 
the quantities with graduated measuring glasses or marked 
glass spoons. Do not use household utensils unless the 
others are not available. 

7. When measuring fluids hold the graduate so that the 
surface of the fluid, which is usually curved, is on a level with 
the eye. The quantity is read when the lowest part of this 
curve is on a line with the mark of the desired quantity, 
thus 



8. Never pour a medicine back into the bottle. 

9. A medicine which forms a precipitate with another 
substance should always be given alone. Such medicines 
are said to be incompatible. 

10. All the medicines being administered in the ward 
should be listed. There are several methods of doing this. 
The most common one is to have a distinctive color for the 
various times of administration. These are placed on a 



THE ADMINISTRATION OF MEDICINES 81 

board near the medicine chest, together with the names of 
the patients. 

11. All medicines should be appropriately marked as soon 
as prepared. 

12. Give all medicines at the times ordered; b. i. d. 
medicines should be given at 8 a. m. and 6 p. m., t. i. d. 
medicines should be given at 8 a. m., 12 m. and 6 p. m. 

13. Always stand at the patient's bedside until the medi- 
cine is taken. 

14. Never allow one patient to administer medicines to 
another. 

THE PRINCIPLES OF ADMINISTRATION 

Drugs are given to cause local or general effects, or both. 
Local effects result from a direct application of a substance 
to a tissue or organ, thus changing its structure or function. 

General or systemic effects result when a drug enters the 
blood stream and affects tissues or organs remote from the 
site of application. 

It is frequently essential for the nurse to know the effect 
that is desired, as the method of administration may vary 
accordingly. 

ADMINISTRATION FOR LOCAL EFFECTS 

For a local effect it is merely desired to bring the remedy 
in contact with a diseased tissue or organ. As a rule, the 
more prolonged the contact the greater is the effect. Local 
remedies are usually applied in the following forms : 

Solutions 

Liniments 

Ointments 

Oleates 

Cerates 

Poultices 

Plasters 

Powders 

Lozenges 

Bougies 

Suppositories 



Applied only on skin 



82 MATERIA MEDICA 

Administration of Solutions 

Substances are usually applied locally in solutions for theii 
antiseptic effect : to check the growth of bacteria. The longer 
the solution is in contact with the wound the greater is the 
antiseptic action. The solution must be changed frequently, 
however, since the effect soon wears off. 

The best antiseptic action is obtained by keeping the 
wound in a continuous bath of the solution; which is not 
alwaj^s possible, however. 

Other Methods of Applying Solutions 
Wet Dressings 
The most conmion wa}^ in which antiseptics are apphed is 
by means of gauze which has been soaked in the required 
solution. The dressings are kept moist b}^ frequent changing 
or by covering with rubber tissue. Frequent changing is 
the better method since it not only keeps the dressings moist 
but drains the secretions and keeps the wound dry. 

Administration of Douches 

Solutions used as douches are given for their antiseptic or 
constricting (astringent) effect on the mucous membrane of 
the vagina and cervix, and to remove accumulated secre- 
tions. Douches are also given to check bleeding from the 
uterus or cervix, and to lessen pain produced by their con- 
traction. Contact with the diseased tissues is essential for 
the effect. It is especiall}^ important that every part of the 
vaginal fornix be irrigated to remove the secretions which 
usuall}^ accumulate in these regions. 

Method: The patient should he flat on the back with the 
thighs and legs flexed and a pillow underneath the buttock. 
The sterilized nozzle is then inserted far back into the vaginal 
fornix. The fluid is allowed to run from the bag held about 
two feet above the patient, and the nozzle gently moved about 
to distribute the fluid over the entire mucous membrane. 

For an antiseptic or an astringent effect, or for drainage, 
the temperature of the fluid should be that of the body, 
about 100° F. To check bleeding or to lessen pain, solutions 
should be as hot as the patient can stand. 



THE ADMINISTRATION OF MEDICINES 83 

Administration of Mouth Washes and Gargles 

Mouth washes and gargles are used for diseased conditions 
of the mouth and throat: to cause an antiseptic or a con- 
stricting (astringent) effect. In administering mouth washes 
and gargles it is essential to bring the drug in contact with 
every part of the lining membrane of the mouth and throat. 
This is usually accompUshed by keeping the fluid in the 
mouth and moving it about by means of a current of ex- 
pired air. 

Fluids applied in this manner do not affect the tonsils or 
pharynx to any extent, since they do not reach back far 
enough. Local applications to these tissues are best applied 
by sprays or irrigations. 

Irrigation is a very good method for applying medicines to 
the throat. It is usually done by means of a glass nozzle 
attached to an irrigating bag, with the patient lying down, 
the head on the side and the mouth and chin slightly tilted 
forward. 

Administration of Liniments 

Liniments are usually applied for their soothing effect. 
They should be apphed on a piece of flannel or hnt which 
keeps the skin warm, prevents evaporation of the liniment 
and thereby helps the action. Many liniments are applied 
by vigorous rubbing. Whatever effect is then produced is 
due principally to the vigorous massage and very little, if 
any, to the liniment itself. 

Administration of Ointments 

Ointments may be apphed for a local or a general effect. 
They are the best means of applying remedies for a prolonged 
local effect. The fat in which the drug is contained dis- 
solves readily but does not evaporate, thus prolonging the 
effect of the drug on the site of application. 

The ointment should be spread on a piece of flannel or Hnt 
and applied to the site ordered; it should be changed fre- 
quently; about every day. Ointments should be avoided on 
discharging wounds as they prevent free drainage of the 



84 MATERIA MEDICA 

secretions. For a general effect they are applied by rubbing. 
See page 102. 

Oleates and Cerates are administered like ointments. 

Admimstration of Poultices and Plasters 
Poultices and plasters are usually applied to produce the 
following effects: 

1. To reUeve pain. 

2. To dilate the blood vessels of the skin (rubefacient 
action) . Blood is thus brought to the surface from the deeper 
tissues or organs, reheving congestion and inflammation 
of many organs. Poultices or plasters cause other reflex 
effects. (See Counterhritants.) 

3. To produce bhsters. This is merely an exaggeration 
of the rubefacient effect as the result of a prolonged apphca- 
tion or of a stronger preparation. 

Poultices are usually diluted with flour until the desired 
strength is obtained. They are moistened and wrapped in a 
piece of gauze or lint and appHed to the site ordered. 

Plasters should be moistened in lukewarm water before 
being applied. 

Poultices or plasters should remain on the skin for ten to 
twenty mmutes to induce a rubefacient action and longer for 
the formation of a bhster. The nurse may vary the duration 
of the application, however, so as to obtain the desired effect. 
Some plasters such as mercury plaster may be kept on the 
skin for days. 

Other Forms of Local Administration 

Powders are usually dusted over the surface of a wound or 
ulcer. 

Lozenges are kept in the mouth; they are dissolved by the 
saliva, and the medicinal substances which they contain 
then affect the mucous membrane of the mouth. 

Bougies are long thin medicated tubes, made mth wax. 
They dissolve in mucous membrane hned cavities, and then 
produce either local or general effects. 

Suppositories are cone-shaped preparations of drugs made 
with cocoa butter, and are appHed in the same manner 
as bougies. 



THE ADMINISTRATION OF MEDICINES 85 

ADMINISTRATION FOR GENERAL OR SYSTEMIC 
EFFECTS 

When a remedy is given for a general or systemic effect, to 
act upon organs and tissues remote from the site of apphca- 
tion, the drug must enter the blood stream. Thus it will 
reach, through the circulating blood, the organ or tissue for 
which it has a selective action and induce the desired effects. 
By the chemical combination of the drug with some of the 
constituents of the cells of these organs, certain desired 
changes in the activity of the organs are brought about. For 
example, when a dose of morphine sulphate is given to a 
patient to relieve pain, the dose is dissolved in the gastric juice 
and passes through the mucous membrane of the stomach 
into the blood stream. Here it is carried by the moving 
stream until it reaches the cells of the gray matter which are 
selectively affected by the morphine. It then affects the 
areas in the brain which appreciate pain. A chemical com- 
bination of the morphine and some of these cells probably 
occurs, thus lessening their function and pain is therefore 
not appreciated. 

The simplest way in which general effects are produced is 
by directly injecting the drug into one of the veins. The 
following are the methods used for administration for 
general effects arranged in the order of the rapidity with 
which the effects are produced: 

1. Intravenous method 

2. Intramuscular method 

3. Hypodermic method 

4. By mouth 

5. By rectum 

6. By the skin 

Intravenous Administration 

Intravenous Injection 

The median basillic or median cephalic vein of the front 
of the elbow is the most suitable vein for injecting drugs. 
A rubber or gauze bandage is tightly wound around the 
nxiddle of the arm and the hand is gripped firmly while the 



86 MATERIA MEDICA 

forearm is extended. The vein is thus made to stand out 
prominently. The surface of the skin over the vein is then 
sterihzed with green soap, 50% alcohol and a 1:2000 bi- 
chloride of mercury, or the site may be painted with 
tincture of iodine. 

A sterihzed hypodermic syringe is now filled with a sterile 
solution of the drug to be injected, and the air expelled from 
the syringe. The needle is then inserted into the vein point- 
ing it toward the heart and a few drops of blood shghtly 
withdrawn from the vein. When blood enters the syringe 
you are sure the needle is in the vein. 

The bandage of the arm may now be loosened and the 
solution of the drug should be injected very slowly. Slow 
injection is very important, as serious, even fatal results 
have occurred from too rapid injection. 

Intravenous Infusion 

The arm is prepared as for an intravenous injection. The 
fluid is made up in a special sterile glass jar which is placed 
on a stand above the level of the patient. To this glass jar is 
attached a rubber tube and a needle, or cannula. The 
needle is inserted into the vein, pointing it toward the 
heart and the fluid is then allowed to flow. If a cannula is 
used, the vein must be exposed, opened, and the cannula 
inserted into the open vein in a direction toward the heart. 
The effects of an injection appear almost immediately. 

Intramuscular Administration 

The site for an intramuscular injection is usually one of the 
buttocks, or the front of one of the thighs. The skin over 
the site of injection is sterihzed in the usual manner. A 
sterihzed hypodermic syringe is filled with a well diluted 
solution of the drug to be injected and fitted with a large 
firm needle. The needle is then inserted perpendicularly 
into the muscles. The syringe may now be withdrawn 
or shghtly aspirated. If blood is obtained a new site must 
be chosen as the needle has probably been stuck into a 
vein. If no blood is obtained the solution may be injected, 
but very slowly; and the area of injection shou)i then be 



THE ADMINISTRATION OF MEDICINES 87 

(thoroughly massaged and covered with a httle collodion 
or som3 other dressing. 

Hypodermic Administration 

The best sites for hypodermic injection are the front of the 
thighs, the outer part of the arms and forearms. The skin 
at the site of injection should be sterilized by rubbing with 
50% alcohol. The sterilized syringe is now filled with a well 
diluted solution of the drug to be given and held in the right 
hand with the neck of the sj^inge resting between the index 
and middle finger with the thumb on the piston. The skin 
at the site of injection is then taken between the thumb and 
index finger of the left hand and the needle inserted under 
the skin at an angle of about 45 degrees. The place of in- 
jection should then be thoroughly massaged. 

In giving a hypodermic injection it is very essential to 
inject the drug under the skin, not into the skin. When the 
drug has been injected into the skin the area of injection 
looks hke goose skin and the needle should be withdrawn and 
a new place chosen. This should be sterilized and the in- 
jection repeated. 

The effects of a hypodermic injection usually appear in 
about ten minutes to a half hour, depending upon the 
patient's circulation; the better the circulation the more 
rapid are the effects. 

It may also be noted that the more the drug is diluted the 
better and the more rapid are the effects following a hy- 
podermic injection. 

ADMINISTRATION BY MOUTH 

The most common way in which medicines are given is to 
let the patient drink a fluid which contains the medicine, or 
to swallow it in the form of a pill, capsule, etc. 

In administering any remedy the nurse should consider 
the following points: 

1. Absorption 

2. Desired effect 

3. Taste 

4. Time of administration 



88 MATERIA MEDICA 

Absorption 

Absorption is the process whereby a drug enters the 
blood stream, by passing through the hning merobrane of 
the stomach or intestines or from the tissues. 

Except in the case of acids, alkahes, salts, and a few other 
substances, our knowledge of the absorption of remedies is as 
yet very meager. Most drugs are absorbed in the stomach 
and intestines but in their own particular way. Some drugs 
are readily absorbed while others are not absorbed at all. 
However, we do know that they are all chemical substances 
and must therefore follow definite chemical laws. 

Physical Chemistry of Remedies and Absorption 

Let the reader picture to herself what happens to any 
remedy when it is given by mouth. As soon as it enters the 
stomach, no matter whether it is given in fluid or solid 
form, it becomes dissolved in the gastric juice, and in many 
instances in the intestinal juice. Some remedies may be 
digested by the gastric or intestinal juice, but their condition 
will not be changed except that they are decomposed into 
simpler substances. The fate then, of any remedy when 
dissolved in either the gastric or intestinal juice will de- 
pend upon the innate absorbability of the substance and 
upon the laws of physical chemistry governing solutions. 
These laws have been definitely determined in the case of 
such simple substances as acids, alkahes and salts. Since 
other absorbable substances can only be absorbed when they 
are in solution, they should be administered in the same way 
in which we know the absorption of the salts, acids and 
alkalies is increased. 

Chemistry of Solutions 

Any substance when dissolved is capable of undergoing 
the following changes: 

1. Diffusion. This is a process whereby one fluid is able to 
pass into another. Usually the more concentrated solution 
passes into the less concentrated one, until each contains the 
same ingredients in a similar concentration. It is by such a 



THE ADMINISTRATION OF MEDICINES 89 

process that substances are able to dissolve, and it is by the 
same process that medicinal substances are enabled to mix 
with the gastric or intestinal juice and vice versa. As a rule, 
the more diffusible substances are more readily absorbed. 

2. Osmosis: This is a property whereby one solution is 
able to penetrate into another through an animal mem= 
brane. The stronger solution usually withdraws fluid from 
the weaker one until both fluids contain the same substances 
in the same concentration. The passage of various salt solu- 
tions from the intestines into the blood stream and the with- 
drawal of fluid from the blood are due to such a process. 
As a rule, a solution which is more dilute, and therefore has less 
osmotic power is more readily absorbed. 

Dissociation: This is a process whereby many salts, acids 
and alkalies dissolved in a fluid will separate into two groups 
of atoms which are capable of carrying electricity. Each 
group of atoms is called an ion and consists of one or more 
atoms. The group charged with positive electricity is called 
a cation, and the one charged with negative electricity is 
called an anion. An ion differs from an atom in the follow- 
ing ways : It is charged with electricity and consists of one 
or more atoms. Substances occur as ions only when they 
are dissolved, and not when in the solid state. 

For example, when we dissolve sodium chloride in water, 
it soon becomes separated (dissociated) into groups of atoms 
of sodium, which are charged with positive electricity 
(sodium cations) and groups of atoms of chlorine which are 
charged with negative electricity (chlorine anions) . 

Substances which are in solution and which exist in the state 
of ions are more readily absorbed, are capable of inducing the 
greatest degree of chemical action and therefore produce better 
pharmacological effects. In the blood the salts always exist 
in the form of ions. 

Factors Influencing Dissociation: 

The degree and rapidity with which a substance will dis- 
sociate into its ions depend upon the character and quan- 
tity of the fluid in which it is dissolved. 

The character of the solvent: Water and weak acids are 



90 MATERIA MEDICA 

the fluids in which substances dissociate most readily into 
their ions. 

For practical purposes, water is the fluid in which dissocia- 
tion takes place most readily. The degree of dissocia- 
tion in other fluids depends upon the percentage of water 
they contain. Thus substances will dissociate most readily 
in alcoholic beverages that contain the smallest percentage 
of alcohol. In syrups, in oils and in colloids (albuminous 
fluids) such as milk, dissolved substances separate very 
slowly into ions, if at all. 

The quantity of fluid: The greater the quantity of fluid 
in which a substance. is dissolved and therefore the more 
dilute the solution up to a strength of about 1 : 1000 the 
greater is the degree of dissociation of the dissolved sub- 
stance in it. When this dilution is reached the degree of 
dissociation does not increase. 

Dissociating power of various drugs: Some substances dis- 
sociate into ions, others do not. Acids and many absorbable 
salts dissociate most readily. Of the substances that do 
dissociate, the more simple inorganic chemical substances 
separate more readily into their ions than the more com- 
plex organic ones. Whatever power of dissociation each sub- 
stance has, however, may be increased by dissolving it in a 
large quantity of water. 

How to Aid Absorption 

The following facts based upon the foregoing principles will 
enable the nurse to administer most drugs so as to increase 
their absorption. 

(1) Any substance usually given to produce a general 
effect is capable of being absorbed. 

(2) Substances that are capable of being absorbed can 
only be absorbed when dissolved in a fluid (before adminis- 
tration or in the stomach or intestines) . 

(3) In administering a remedy the greatest degree of ab- 
sorption of which it is capable will be brought about when it 
is given in a medium in which most absorption can take place. 

The following is a list of fluids in which medicines are 
commonly given, arranged according to the rapidity with 



THE ADMINISTRATION OF MEDICINES 91 

which they are absorbed and according to the degree with 
which they separate dissolved substances into their ions. 

1. Water 

2. Weak acids 

3. Alcoholic beverages 

4. Syrups 

5. Oils 

6. Colloids (albuminous solutions) 

(4) A substance is absorbed most readily when it is dis- 
solved in water. With the possible exception of lemonade 
and grape juice weak acids are seldom used as mediums in 
which to administer medicines. 

(5) Alcohol and oils will aid the absorption of whatever 
substances may be dissolved in them, because they them- 
selves are easily absorbed, although dissociation does not 
readily occur in such fluids. 

(6) The larger the quantity of fluid in which a substance is 
dissolved the more readily will the dissolved substance be 
absorbed, because in a dilute solution a substance is readily 
diffusible and has a low osmotic power. Better pharmaco- 
logical effects will be obtained from such a solution because 
dissolved substances dissociate readily in it and are, there- 
fore, more active. 

(7) More absorption takes place after meals than before 
meals, because the stomach and intestines are supplied with 
more blood at that time and the capillaries and lymphatics 
are widened. 

(8) Substances which combine with foods cannot be 
absorbed, until the chemical combination is broken down by 
the digestion of the food. 

(9) In general, simpler inorganic substances are absorbed 
more readily than the more complex organic ones. However, 
some substances are readily absorbed while others are not. 
There is no rule to determine this. 

Desired Effect 

In administering medicines by mouth it is often essential 
for ^.he nurse to know whether a local or a general effect is 



92 MATERIA MEDICA 

desired. For a general effect absorption should be aided 
and for a local effect it should be lessened. . 

Taste 

Taste is a very important factor from the patient's stand- 
point. A patient may dislike a remedy because of its bitter, 
bland or unpleasant taste. The bitter taste is often necessary 
for the effect and should not be disguised. When the un« 
pleasant taste is not necessary for the effect it may be les- 
sened by giving the remedy in a large quantity of fluid or in 
syrup, wine or jam. 

Oils such as castor oil should be given in the form of a 
cocktail or as an emulsion with lemon, orange, or grape 
juice. Very small quantities of an oil should be given on a 
lump of sugar or in melted butter. 

The taste of powders may be disguised by placing the 
powder in a capsule, cachet or konseal or by wrapping it in 
a small disk of rice paper. 

Unpleasant tasting fluids should be given cold, followed 
by a copious drink of water. 

Time of Admiiiistiation 

The time to administer most remedies is not as impor- 
tant as patients frequently imagine. For certain effects, 
however, certain times of administration are preferable to 
others. 

Remedies should be given before meals for the following 
effects : 

1. To aid the appetite or to increase the secretion of 
digestive juices. 

2. For a local effect on the stomach or intestines. When 
the substances are irritating they should be given in m.ilk. 
The combination of the remedy with the protein of the food 
lessens the irritation. 

Remedies should be given after meals, for the following 
effects : 

1. To neutrahze digestive juices when these are present 
in excess. 



THE ADMINISTRATION OF MEDICINES 93 

2. To aid absorption and produce rapid effects. 

3. Remedies which are given for absorption, but which are 
irritating to the tissues. The irritation is lessened by the 
combination of the remedy with the protein of the food. 

Cathartics should be given between meals on an empty 
stomach. Those acting slowl}^ should be given at night. 
Those acting quickly should be given in the morning. 

Rules for Administration by Mouth 

1. For a rapid general effect give the substance diluted in a 
large quantity of water immediately after meals, thus aiding 
absorption. 

2. For a slow gradual general effect give substances in 
small quantities of syrup, milk or wine between meals, to 
retard absorption. 

3. For a local effect on the stomach or intestines give the 
substance in acacia or mineral oil, thus lessening absorption. 

4. Taste and time as indicated above. 

Protection of Mouth and Teeth 

Remedies which are injurious to the teeth such as iron or 
acids should be given through a glass tube or straw. 

Administration to Children 

To children medicines should always be given in fluid form. 
Special care should be taken to thoroughly disguise sub- 
stances having an unpleasant taste. Pills, tablets or capsules 
should not be given to children as they are apt to chew these 
preparations before swallowing them. 

Administration to Unconscious or Insane Patients 

Unconscious or insane patients who are unwilhng to take 
medicines should be given substances only in fluid form. The 
medicine should be dropped on the back of the tongue with a 
small spoon. To insane patients it is frequently necessary 
to administer medicine through a narrow stomach tube 
passed through the nose. 



94 MATERIA MEDIGA 

ADMINISTRATION OF VARIOUS REMEDIES 

Administration of Acids 

The dilute acids are usually given to replace acid in the 
stomach when its secretion is diminished. They may injure 
the enamel of the teeth, so that they must be given through 
a glass tube or straw. In giving acids an attempt should 
be made to imitate the normal secretion of acid in the 
stomach. This is best accomplished by dissolving the dose 
in a large quantity of water and allowing the patient to 
sip it slowly through a glass tube or straw. 

Administration of Inorganic Salts 

Inorganic salts are of two kinds: alkaline* and metallic. 
The alknline salts that are not readily absorbed are used to 
neutralize excessive acid in the stomach and as carthartics, 
while those that are readily absorbed are used as diuretics. 
Of the metallic salts, mercury, iron and arsenic are the 
ones commonly used for absorption. The others are oc- 
casionally used, but only for their local effects. 

Saline Cathartics : Most of the salts used as cathartics are 
not readily absorbed, even when given in very dilute solu- 
tions. They usually act merely by withdrawing fluid into 
the intestines from the tissues and blood. The more con- 
centrated the salt solution, that is, the greater its per- 
centage of salt than the blood, the more is the quantity of 
fluid mthdrawn. When enough fluid passes into the intes- 
tines to distend them, bowel movements result. Practically, 
with concentrated solutions this takes quite some time, 
but with dilute solutions it occurs more rapidly. It is 
therefore better to give sahne cathartics in dilute solutions; 
that is, in one or two tumblerfuls of water, before breakfast, 
when the stomach is empty, to avoid chemical combinations 
with the food. 

To remove fluids from the tissues to relieve oedema, salts 
should be given concentrated, very slightly diluted, since 
they will then withdraw more fluid. 

Saline Diuretics: The salts given as diuretics are usually 
readily absorbed. Only part of the salt, however, is ab- 

* For administration of alkalies and alkaline salts, see page 100. 



THE ADMINISTRATION OF MEDICINES 95 

sorbed, but a sufficient quantity to act upon the kidneys. 
Saline diuretics should be given in a large quantity of water, 
in one or two tumblerfuls, between meals. 

Metallic Salts; The metalhc salts dissociate rapidly into 
their ions^ but they combine readily with the proteins of the 
cells of the mucous membrane of the stomach and intestines 
with which they come in contact. If this chemical com- 
bination takes place to any degree, the cells become injured. 
This irritation is responsible for the symptoms of poisoning, 
such as vomiting, diarrhoea, etc., that follow the use of many 
metals. When the albuminate formed by the combination 
of the metal and the cells dissolves readily in the excess of 
fluid protein with which the body cells are constantly bathed, 
the metal is absorbed and general or systemic symptoms 
result. This is the case with substances such as ^nercury, 
iron and arsenic which are usually given for their general 
effects. Absorption of these salts may be increased then, 
by giving them in a large quantity of a fluid, such as milk. 
In such a fluid the metal readily combines with the pro- 
teins, the irritation is avoided, and at the same time absorp- 
tion is aided. 

For a local effect, the metalhc salts should be given in 
smaller quantities of a similar fluid, but between meals; 
since there is not as much absorption from smaller quanti- 
ties of fluid, and at this time. The salts commonly given 
for local effects are the preparations of bismuth. 

The organic preparations of the metals are already com- 
bined with an albumin. The metals that are absorbable 
are therefore more readily absorbed while those that are not 
usually absorbed are less irritating. 

The Iodides and Nitrites: The iodides and nitrites also 
dissociate very readily and combine rapidly with the al- 
bumins of the cells of the stomach and intestines. This 
accounts for the pain in the region of the stomach which 
occasionally follows the use of such preparations as potas- 
sium iodide. To lessen th»^ irritation, the iodides should be 
given in a glass of milk after meals. A little wine, sarsapa- 
rilla or cinnamon water may be added to disguise the salty 
taste. 



96 MATERIA MEDICA 

Administration of Alkaloids and Their Salts 

The alkaloids themselves do not dissolve readily and are 
therefore not absorbed. They are usually given, however, 
in the form of salts which they readily form with acids. 
Some of the salts, such as hydrochlorides and sulphates, 
are absorbed more readily than others. These salts are 
therefore preferable for rapid effects. 

The alkaloids should always be given in a large quantity 
of water (about a wineglassf ul to half a tumblerful) , so as to 
increase the absorption. They have a bitter taste, however, 
which may be lessened by adding a little syrup, raspberry 
juice or cinnamon water. 

It has long been known empirically that very dilute solu- 
tions of the salts of the alkaloids are the most efficient 
preparations. For example, the efficiency of Magendie's 
solution of morphine sulphate is due to the fact that it is a 
dilute 1 : 30 watery solution which is rapidly absorbed. 

Administration of Glucosides 

Most of the glucosides are relatively insoluble substances 
and are therefore, not readily absorbed. They are slowly 
absorbed, however, from many of the galenical preparations 
of their crude drugs such as tinctures, infusions, fluid- 
extracts, etc. We shall consider the administration of these 
substances together with the other galenical preparations. 
There are, however, a number of new preparations of glu- 
cosides which have been made soluble, such as those of 
digitalis. Of these, perhaps the most commonly used 
preparations are digalen, strophantin, and ouabain. These 
are usually given for rapid effects and should be administered 
in about a wineglassf ul of water flavored with just a little 
syrup. 

Administration of Galenical or Physical Preparations 

The galenical preparations are made from the crude drug 
by purely physical means. They are the extracts, tinctures, 
infusions J fluidextracts, etc. These preparations contain 



THE ADMI^'ISTRATIOX OF MEDICINES 91 

the crade drug in a more or less diluted form. The fluid 
preparations are more active than the solid ones. 

The galenical preparations should always be given well 
diluted in a wineglassful to a tumblerful of water. The 
preparations which have an unpleasant taste may be given 
in diluted s}Tup, raspberry juice or wine. 

The effects of the physical preparations appear very slowly 
because their active principles are but slowly absorbed from 
the preparations. 

Administration of Hypnotics 

Most of the drugs used as h^-pnotics are substances of a 
comparatively complex chemical structure and are slowly 
absorbed. They are usuaUy given for effects that are to last 
for several hours. They should be administered in a tumbler- 
ful of warm milk or beer, about a hah to two hours before 
the usual bedtime, the actual time depending on the rapid- 
ity with which the particular drug is absorbed. 

The slow absorption of a substance such as sulphonal 
may be somewhat increased by giving it in milk well diluted 
with water. 

The nurse should avoid giving chloral in small quantities 
of water, which tend to cause irritation of the stomach and 
rapid absorption. 

WTien giving hypnotics by the rectum they should be 
dissolved in about two ounces of boiled starch and injected 
into the rectum through a catheter by means of a s^Tinge. 

Administration of Coal Tar and Newer Synthetic Drugs 

This group includes such substances as phenacetine, 
acetanihd, antipjTine, p:vTamidon and many of their de- 
rivatives. Sahcyhc acid and its newer compounds such 
as aspirin are given in the same manner. 

These substances should be given between meals in about 
a wineglassful of mne or milk. Wine is perhaps preferable 
because the alcohol will tend to overcome the weakening 
action on the heart of many of these substances. The coal 
tar substances should be given in small quantities of fluid 
for slow absorption. This prevents the sudden formation of 



08 MATERIA MEDICA 

large quantities of the substances which are responsible for 
their poisonous effects. 

Administration of Oils 

Oils are given for nourishment or as laxatives. They are 
broken up in the intestines into fine' globules by the bile and 
pancreatic juice, and are then decomposed into their con- 
stituent fatty acids. These may be combined again and 
stored up in the body as fatty tissue. Many of the fatty 
acids thus formed in the intestines are substances which have 
a decided cathartic effect. The oils given as cathartics us- 
ually have a very unpleasant taste which must be disguised. 
This is usually done by giving the oil with raspberry juice, 
wine, soda water, lemon juice or whiskey. These fluids pre- 
vent the contact of the oil with the taste buds in the mouth 
and thus impart their own taste to the tongue rather than that 
of the oil. It is not essential that oils used as cathartics should 
be fresh. Old rancid oil is often better, as it has already been 
changed to fatty acids which are responsible for the effect. 

Administration of Mineral Oil 

Liquid petrolatum, mineral oil, or liquid paraffin is 
usually given merely to prevent absorption of water; thus 
increasing the bulk of the foeces, and lubricating the intes- 
tinal tract, and movements of the bowels result. These 
substances should be given undiluted about two hours after 
meals, perhaps slightly fiavored with a little peppermint, 
raspberry juice or cinnamon water. 

ADMINISTRATION BY RECTUM 

Remedies are given by rectum for the following effects: 

1. To move the bowels. 

2. To medicate diseased condition of the rectum, sigmoid 
or colon. 

3. For absorption, to cause general effects. 

Enema: For a cathartic effect the object of injecting a fluid 
into the rectum is merely to distend the bowels. This starts 
peristalsis and causes movements of the bowels. Drugs are 
usually given for this effect by means of an enema. When 



THE ADMINISTRATION OF MEDICINES 90 

it is desired to inject fluid into the sigmoid or descending 
colon the patient should be placed in the knee elbow position. 

Irrigation: To affect the mucous membrane of the rectum 
or descending colon or to remove gas or fluid, irrigations are 
used. The method consists of injecting fluid into the rectum 
and siphoning it back. An ordinary enema can, with a tube 
and tip is used. The lubricated tip is inserted into the 
rectum, the fluid is allowed to run in and is then siphoned 
back by alternately elevating and lowering the can. Every 
time the can is lowered below the level of the patient the 
fluid should return from the rectum. 

An excellent method of irrigating is by means of Kemp's 
irrigating tube, which consists of an inflow and outflow tube 
in one. The inflow tube is connected with the can by means 
of a rubber tube. When the fluid is allowed to run into the 
rectum it returns through the outflow tube. 

For absorption: Remedies are frequently given by rectum 
for absorption, in cases where it may not be possible or 
where it is harmful to administer them by mouth. They may 
be given in the form of suppositories which consist of cocoa 
butter impregnated with the drug. These are inserted into 
the rectum, the cocoa butter dissolves, is absorbed and 
carries the drug with it into the blood stream. 

Substances are absorbed more readily from the rectum, 
however, when given by the Rectoclysis or Murphy method. 
The method is the same as an irrigation, but a return flow is 
not desired. The essential feature of this method is to allow 
the fluid to run in slowly, drop by drop, so that it is absorbed 
and does not distend the intestine. The drug to be admin- 
istered should be dissolved in a large quantity of water (about 
a pint to a quart) . Normal salt solution should not be used as 
a solvent as it is not absorbed as readily as water. Many 
remedies such as the salicylates are occasionally given by 
this method. 

Although substances are not absorbed as readily from the 
rectum as from the small intestine, the chemical changes that 
may occur with the food or in the passage through the liver 
may thus be avoided, and the substances then enter the 
blood in a pure form. 



100 



MATERIA MEDICA 



METHODS FOR INTERNAL ADMINISTRATION OF 
COMMON REMEDIES 



Based on Physico-chemical Laws 



Drug 


. ., — 

Time of 
Administration 


Character and 

Quantity of 

Fluid 


Method of 
Administration 


Acids: 

Dilute hydrochloric 
Dilute sulphuric 
Dilute nitric, etc. 


Before or with 
meals. 


In tumblerful of 
water. 


[ Sipped through 
j a glass tube or 
I straw. 


Alkalies: 

Sodium bicarbonate 
Lime water 
Calcium salts, etc. 


For effect in stom- 
ach after tneals. 

For general effects 
before or between 
meals. 


In half wineglass- 
f ul of milk. 

In glass of water. 




Inorganic Salts: 
Sodium sulphate 
Sodium phosphate 
Potassium sulphate 
Potassium and sodium 

tartrate (Rochelle 

salt) 
Magnesium sulphate 
Carlsbad water 
Magnesium citrate 


In the .morning ] 
on an empty [■ 
stomach J 


To lessen oedema, 
in wineglassful of 
water. 

For cathartic or 
diuretic effect in 
glass (or more) of 
water. 


'' Dissolve each 
Seidlitz Powder 
in g to 1 glass of 


Potassium bitartrate 

Potassium | * pp^fp 
Sodium 1 Acetate 

Potassium 1^., , 
Sodium jC^^^^^t^ 

Iodides -j 

Nitroglycerine, nitrites, \ 

etc. J 


After meals 


In glassful of 
milk, flavored 
with a Httle 
sarsaparilla, 
wine or cinna- 
mon water. 


water and mix 
the two to- 
[ gether. 


Metallic Salts: 
Mercury ] 
Iron \ Salts 
Arsenic j 
Silver 1 used as as- 
Zinc, etc. j tringents 
Bismuth salts 
Barium 


For absorption af- 
ter meals 

For local effect be- 
tween meals. 


In glass of milk 

In small quantity 
of milk. 


Iron prepara- 
tions should be 
sipped through 
a glass tube or 
[ straw. 

For X Ray pic- 
tures, in glass of 
milk or as por- 
ridge. 


Alkaloid Salts: 
Morphine 
Atropine 
Strychnine, etc. 

Quinine j 


salts 


After meals. 

As bitter, before 

meals. 
As bitter, before 

meals, undiluted. 


In wineglassful of 
water slightly 
flavored. 

In wineglassful of 
sherry wine. 





THE ADMINISTRATION OF MEDICINES 



101 



Drug 


Time of 
Administration 


Character and 

Quantity of 

Fluid 


Method of 
Administration 


Glucosides: 1 








Digalen | 








Strophantin 


Between meals. . . 


In glass of water 




Ouabain 




slightly flavored. 




Digitalis Preparations 








Galenicals: i 








Extracts 




Well diluted in a 




Infusions 




large glass of wa- 




Fluidextracts f 




ter. 




Tinctures, etc. 




Undiluted and un- 




Bitters 


Before meals. 


flavored. 




Hypnotics: 








Chloral 

Trional ] 
Tetronal ^ 
Veronal J 


15 min. before 
bed-time. 
2 to 2 hours before 


In glass of warm 
milk or in beer. 


f May be givea 
per rectum in 
§ ii of boiled 


bed-time 


i 


starch solution, 


Sulphonal 


2 to 3 hours before 


[ Milk should be 
{ well diluted 
[ with water. 


injected with a 


Paraldehyde, etc. 


bed-time. 


glass syringe 
through a cath- 








i eter. 


Coal Tar and Synthetic 








Drugs: 








Phenacetine 








Acetanilid 


Between meals. . . 


In wineglass of 




Antipyrine 




wdne or milk. 




Pyramidon 








Salicylates 








Aspirin, etc. 








Oils: 1 




f In wineglassful 




Olive oil _ 


1 or 2 hours after 


of brandy, 




Cod liver oil 


meals 


wine or lemon 
j juice "Cocktail 




Castor oil 










method" or as 








emulsion. 








One or two 


To unconscious or 






drops dissolved 


insane patients: 






in gb^cerine, 


Placed on back 


Croton oil 




olive oil, or 


of tongue with 






butter, or on a 


a spoon. 






piece of bread 








. or sugar. 




Hydrocarbons: 




Add just a little 




Liquid Petrolatum 




peppermint, 




(Mineral oil) [ 




raspberry juice 




Liquid vaseline | 




or cinnamon 




Albolene | 




water to flavor.! 




Russian mineral oil, etc. J 


1 1 





102 MATERIA MEDICA 

ADMINISTRATION BY INHALATION 

Many substances are frequently given by inhalation. 
The drug is usually dissolved in water which is kept con- 
stantly boiUng so that steam is formed. This may be done 
in a specially constructed apparatus (croup kettle), or in an 
ordinary dish. The patient sits under an impr: vised tent 
and inhales the medicated steam. 

Drugs such as stramonium are frequently given by in- 
halation by merely burning the leaves in a saucer or by 
having the patient smoke cigarettes made from such leaves. 

ADMINISTRATIONS BY INUNCTIONS 

Drugs are frequently given for absorption by rubbing on 
the skin. They are usually apphed in the form of an oint- 
ment from which the drug is absorbed and produces its 
effects. The ointment must be rubbed over a large area of 
skin to get the greatest amount of absorption, and since the 
pores of the skin frequently get clogged up with it after 
constant use, a different region of the body should be used 
every day. Six successive daily rubbings on various parts 
of the body are called a '^course.'' The coiu*se is usually 
given in the following order : 

Each thigh, each arm, the chest, and finally the back. On 
the seventh day the patient should be given a bath to 
eliminate the drug and then the course is begun again. 

^^Tien administering potent remedies by means of rub- 
bings, the nurse should protect her hands by old kid gloves 
or by rubbing the ointment with a piece of chamois. Other- 
wise she may absorb it herself and get poisonous effects. 
The efficiency of the method depends largely on the vigor 
with which the ointment is rubbed and the extent of sur- 
face upon which the ointment is rubbed. 

ADMINISTRATION BY VAPOR 

Some substances, such as mercury, are frequently given by 
means of vapor formed by burning some of the preparations. 
The patient sits in a small closed cabinet over the fumes 
formed by burning the drug in a saucer, the head protrud- 
ing from the top. The vapor generated in the cabinet is ab- 
sorbed bv the skin and induces the desired effects. 



PART II— DRUGS USED PRINCIPALLY FOR THEIR EF-- 
FECTS ON THE STOMACH OR INTESTINES 

CHAPTER VI 

ACIDS AND ALKALIES 

Physiology of the Stomach 

The stomach changes certain kinds of food (proteins), 
such as eggs, meat, etc. to simpler substances of a more 
fluid character. They can then be more easily acted upon 
by the digestive juices of the intestinal tract and are thus 
more readily absorbed through the lining membrane of the 
stomach and intestines. The process whereby the food is 
changed to simple fluid substances which can be absorbed 
is called digestion. 

The digestion of the food is partly brought about by means 
of the gastric juice, which is secreted by the lining membrane 
of the stomach. This juice contains two ferments: pepsin 
and rennin, which together with hydrochloric acid, also 
secreted in the stomach, change the complex food substances 
into simpler substances of a more fluid character. 

While these changes are going on, the contractions of 
the involuntary muscles (peristalsis) of the stomach wall, 
move the food onward into the intestines, so that the stomach 
is completely emptied in about two hours. 

The functions of the stomach then, are : 

1. Secretory, to secrete gastric juice and digest the food. 

2. Motor, to move the digested food onward, into the 
intestines for further digestion. 

A drug which acts on the stomach may increase one or 
both of these functions, or it may replace the acid or ferments 
which may not be secreted in sufficient quantities. 

ACIDS 

Acids are very sour substances, either fluid or sohd, which 

consist of several chemical elements combined with hydro- 

103 



104 MATERIA MEDICA 

gen. The hydrogen can be replaced by an alkali, thus form* 
ing a salt. 

The acids are divided into two groups : inorganic or mineral 
acids, and plant or organic acids. 

The vegetable or organic acids contain carbon as one of 
the elements, while the inorganic or mineral acids do not con- 
tain carbon. 

Most of the acids are very poisonous substances unless 
they are given in very dilute solutions. 

INORGANIC OR MINERAL ACIDS 

The mineral acids principally used in medicine are hy- 
drochloric, sulphuric, nitric, nitrohydrochloric, and phos- 
phoric acids. They are used principally to replace acid in 
the stomach when its secretion is diminished. The organic 
acids produce practically the same effects as the inorganic 
acids with only slight individual differences. 

ACTION 

Local action: Applied to the skin, or mucous membranes, 

concentrated solutions of acids are very injurious to the 
tissues, and destroy the skin, mucoas membranes and under- 
lying tissues. 

The tissues become shrunken, hard and brittle, because 
the acids withdraw water from the tissues with which they 
come in contact. 

Dilute solutions of the acids usually contract mucous mem- 
branes. 

Internal Action 

In the mouth: The dilute solutions ordinarily used have a 
characteristic sour taste and relieve thirst. They increase 
the flow of saliva and contract the mucous membrane of the 
mouth. 

In the stomach: The acids aid the digestion of protein or 
albuminous food, since the pepsin acts only in the presence of 
an acid, particularly hydrochloric acid. 



ACIDS AND ALKALIES 105 

In the intestines: If the acid enters the intestines, it is 
immediately neutralized by the alkaline juices which are 
always present there. Salts are thus formed, and at the same 
time the pylorus of the stomach immediately closes, to pre- 
vent more acid from entering the intestines. In a reflex 
manner by forming secretin (a ferment which enters the blood 
stream and affects the pancreas), from the cells of the 
pylorus of the stomach the acids increase the secretions of 
the pancreatic juice. 

Action after Absorption 

The acids are rapidly absorbed into the blood from the 
stomach, in combination with proteins or as salts formed with 
the alkalies of the tissues. They then produce no effects, 
except to make the blood somewhat less alkaline in reaction. 
The organic acids, however, are changed to carbonates which 
then act as alkalies. As a rule, the alkalinity of the blood 
is not greatly influenced by acids. 

Excretion 

The acids are eliminated from the body by the urine, as 
acid salts; the alkalies of the salts being kept back in the 
blood. The urine is therefore more acid in character, and 
often slightly injures the kidneys, when the urine may con- 
tain albumin or blood. The patient may also have burning 
pain in the bladder when passing urine. 

Poisonous Effects 

Acute acid poisoning usually results from an acid taken 
with suicidal intent. The poisonous effects of all the acids 
are the same; except that hydrochloric and nitric acids make 
the tissues yellow and hard, while sulphuric acid turns the 
tissues white in color and then brown. 

Symptoms 

1. Severe burning pain in the mouth, throat and stomach. 

The tissues about the mouth become dry, shrunken, white or 
yellow in color. 



106 MATERIA MEDICA 

2. Profuse vomiting. The vomited matter contains blood 
and pieces of mucous membrane. 

3. Profuse diarrhoea, the stools containing blood and pieces 
of mucous membrane. 

As a result of the destruction of the mucous membrane 
of the stomach and intestines, the patient suffers from : 

4. Profound collapse (rapid, thready, weak pulse, slow, 
shallow breathing, subnormal temperature). Death usually 
occurs in several hours. 

Frequently, as a result of lessened alkaUne salts in the 
blood, there occurs: 

5. Difficult breathing. 

6. Twitchings of the muscles or convulsions. 
Occasionally the fumes of the acid may cause swelling 

of the larynx (oedema of the glottis), and the patient may 
then die of asphyxia. 

If the patient recovers, he may suffer from various symp- 
toms produced by the narrowing (stenosis) of the oesophagus, 
because of the scar tissue formed by the healing of the 
wound. 

Treatment 

1. Neutrahze the acid with an alkali; such as magnesia, 
or magnesium carbonate, sodium bicarbonate, or lime water. 

Sodium bicarbonate should be used cautiously as it may 
form carbon dioxide gas and distend the stomach. 

If these substances cannot be obtained, chalk, plaster 
from the wall, soap suds, etc., may be used. Giving plenty 
of water helps to dilute the acid. The stomach may be 
washed out, but with great care, as the stomach tube may 
pass through the injured stomach wall. 

2. Protect the mucous membranes of the oesophagus and 
stomach by white of egg, milk, flour and water, etc. 

3. Keep the patient quiet. 

4. The collapse is treated with heart stimulants, such as 
caffeine, strychnine, atropine, etc, 

5. Sodium bicarbonate solutions are given intravenously 
or per rectum, to increase the alkaline salts in the blood. 



ACIDS AND ALKALIES 107 

Administration 

All the acids should be given before or with meals, well 
diluted, sipped very slowly through a glass tube, so as not 
to injure the teeth. Diarrhoea and griping pains in the ab- 
domen are symptoms of excessive action. 

PREPARATIONS OF THE MINERAL ACIDS 
DILUTE HYDROCHLORIC ACID 

Dilute hydrochloric acid is used principally to aid digestion 
in cases where there is an insufficient amount of hydrochloric 
acid secreted in the stomach; and the pepsin is then unable 
to digest the food. This often occurs in such diseases as 
chronic gastritis, or in infectious diseases. 

It is also used to lessen thirst, especially in fevers, and to 
check intestinal putrefaction and diarrhoea. 

Preparations 

Dilute Hydrochloric Acid 0.3-2.0 c.c m. v-xxx 

(Acidum Hydrochloricum Dilutum) 

It contains 10% of hydrochloric acid. 

For Local Use 
Hydrochloric Acid 
(Acidum Hydrochloricum) 

This contains 31% of hydrochloric acid. 

Oxyntin (not official) 0.3-1.0 gm. grs. v-xv 

This is a compound of protein and hydrochloric acid and 
is used as a substitute for the latter substance for the di- 
gestion of proteins. It is only half as strong as dilute hydro- 
chloric acid. 

SULPHURIC ACID (OIL OF VITRIOL) 

Sulphuric acid acts like the other acids, except that it 
checks intestinal secretions and the sweat. 

It is rarely used except as a remedy for lead poisoning 
and occasionally to check diarrhoea and night sweats. The 



108 MATERIA MEDICA 

concentrated acid is occasionally used to destroy an intected 
area of the skin (caustic action). 

Preparations 

Dilute Sulphuric Acid 0.6-2.0 c.c. m. x-xxx 

(Acidum Sulphuricum Dilutum) 

This contains 10% of sulphuric acid. 

Aromatic Sulphuric Acid 0.3-1.0 c.c. m. v-xv 

(Acidum Sulphuricum Aromaticum) 

This contains 20% of sulphuric acid in alcohol, flavored 
with ginger and cinnamon. 

For Local Use 
Sulphuric Acid 
(Acidum Sulphuricum) 
(Oil of Vitriol) 

This contains 92% of sulphuric acid. 

NITRIC ACID (AQUA FORTIS) 

Nitric acid acts like other acids, except that it is said to 
increase intestinal secretions and the secretion of bile. 
It is occasionally used instead of hydrochloric acid to aid 
digestion, A drop of the strong acid is frequently applied 
on the skin to destroy an infected area. . , _ 

Dilute Nitric Acid 0.6-2.0 c.c. m. x-xxx 

(Acidum Nitricum Dilutum) 

This contains 10% of nitric acid. 

For Local Use : 
Nitric Acid 
(Acidum Nitricum) 

This contains 68% of nitric acid. 



I NITROHYDRO CHLORIC ACID 

Nitrohydrochloric acid or aqua regia, is a mixture of one 
part of nitric and 4 parts of hydrochloric acid. It is the 



ACIDS AND ALKALIES 109 

most powerful acid, and the only fluid which will dissolve 
platinum and gold. 

This acid diluted, is principally used to increase the flow 
of bile, given in the following ways: 

1. By mouth, sipped through a glass tube. 

2. In a foot bath or ordinary bath. 

3. It is said to be more efficient if it is applied to the liver 
in the form of a stupe, about 4.0-8.0 c.c. or 3i-ii of the 
dilute acid being used to a pint of water. 

Preparations 

Dilute Nitrohydrochloric Acid 0.3-1.0 c.c. m. v-xv 
(Acidum Nitrohydrochloricum Dilutum) 

This contains 40 parts of nitric acid and 180 parts of hydro- 
chloric acid in 1000 c.c. of water. 

Dilute phosphoric acid is principally used as a tonic. It 
does not destroy tissues like the other mineral acids. 

PLANT OR ORGANIC ACIDS 

The plant or organic acids are obtained from various 
fruit juices such as the grapes, lemons, or by the prolonged 
fermentation of wines. 

Their effects are similar to those produced by the mineral 
acids, but they are milder, and they act as alkalies after 
absorption. They do not produce poisonous effects, except 
when given in very large doses. 

The organic acids commonly used are acetic, citric and 
tartaric acids. 

The acetic acid is the most active one in the group; the 
others have a milder action. 

DILUTE ACETIC ACID 

Acetic acid is an organic acid formed by the prolonged 
fermentation of various fruits and vegetables. Thus, when 
wine is fermented for a long time, vinegar is formed, which 
consists mostly of acetic acid. 

ACTION 
Local action: Dilute acetic acid hardens and cools the skin; 



no MATERIA MEDIC A 

it contracts the mucous membranes. It checks bleeding by 
contracting the blood vessels. 

Concentrated solutions however, when locally applied, 
cause redness, pain, and the formation of a blister with 
slight destruction of the skin. 

Internal Action 

In the mouth: Dilute acetic acid has a very som^ taste, 
it increases the flow of saliva, thereby lessening thirst. 

In the stomach: It increases the secretion of gastric juice^ 
it improves the appetite, and aids digestion. 

In the intestines: It increases the secretions, but it is 
readily neutralized by the alkaline intestinal juices. 

Action after Absorption 

Acetic acid is rapidly absorbed from the stomach. It 
is oxidized in the blood to carbonic acid. It then forms 
carbonates by combining with the alkaline salts in the blood. 
The carbonates thus formed are excreted by the urine, the 
quantity of which is very much increased. 

Poisonous Effects 

The symptoms of poisoning by large doses of acetic acid, 
are similar to those caused by the mineral acids, but they 
are rarely fatal. The treatment is the same. 

Chronic Poisoning 

Continued use of acetic acid often causes emaciation, 
loss of weight, and anaemia. 

Preparations 
Vinegar (not official) 
Acetum 

Vinegar is obtained by prolonged fermentation of alcoholic 
liquors. The best vinegar is made from cider, and consists 
mostly of acetic acid. 

Dilute Acetic Acid 2.0-8.0 c.c. 5j-ii 

(Acidum Aceticum Dilutum) 



ACIDS AND ALKALIES 111 

This is a pure form of vinegar which contains 6% of 
acetic acid. 

These preparations are used principally to harden the 
skin, to check bleeding; and by inhalation, to relieve fainting 
(reflexly strengthening tne heart action in this way). They 
are also used to neutralize poisoning from alkalies. 

For Local Use 

Glacial Acetic Acid 
(Acidum Aceticum Glaclale) 

This contains 99% of acetic acid. 

Trichloracetic Acid 
(Acidum Trichloraceticum) 

This is a crystalline substance. 

These two latter preparations are used principally to re- 
move warts and to cauterize or destroy tissues. 

CITRIC ACID 

Citric acid is an organic acid which is found in the juice 
of the lemon, or Citrus limonum, and the lime, Citrus bergamia. 

ACTION 

Citric acid acts like acetic acid. 

1. It increases the flow of saliva and relieves thirst. 

2. It increases the appetite and the flow of gastric juice, 
thereby aiding digestion. 

3. It slightly increases the movements of the bowels. 
Thus, the juice of half a lemon, if given before breakfast is 
a good laxative. 

4. It increases the sweat, especially if given hot, as in a 
hot lemonade. 

5. It increases the flow of urine, in which it is excreted 
as an alkaline carbonate, thereby lessening the acidity of 
the urine. 

6. Citric acid is frequentlj^ given on shipboard as an 
article of diet, to prevent scurvy, a severe disease of the 
joints due to the lack of vegetable food in the diet. 



112 MATERIA MEDIC A 

Citric acid is not a poisonous substance, but its continued 
use occasionally causes anaemia and loss of weight. 

Preparations 

Citric Acid 
(Acidum Citricum) 

This is occasionally used in doses of 30.0 gms. (§1), to a 
pint of water; instead of lemonade. 

The best way to administer citric acid is in the form of 
lemonade. To produce sweating it is best given hot. 

TARTARIC ACID 

Tartaric acid is the acid of grape juice. Its action is 
similar to that of acetic acid. 

It is principally used to increase the flow of urine, in which 
it is excreted as alkaline carbonates. 

It is also used as a laxative, and it is an ingredient of the 
seidlitz powder. 

Tartaric acid is usually given in the form of grape juice, 
as a cooling refreshing drink. As a diuretic or laxative, its 
various salts such as potassium tartarate, etc., are preferred. 

LACTIC ACID 

Lactic acid is a thick, syrupy liquid formed in milk wheD 
it turns sour as a result of bacterial fermentation. It is 
also formed by the fermentation of milk sugar or grape sugar. 

ACTION 

When taken internally, it acts like the other organic acids : 

1. It increases the appetite and aids digestion. 

2. It is said to increase nutrition. 

3. It enters the blood as lactates and is excreted by the 
urine as alkaline carbonates. 

It is principally used, however, as a local application to 
heal tuberculous ulcers of the pharynx or larynx, and to 
remove diphtheritic membranes. The applications are very 
painful. 



ACIDS AND ALKALIES 113 

Lactic acid is formed by the fermentation of bacteria in 
milk and is therefore contained in many fermented milks, 
such as KumysS; Zoolak, Fermilac, etc. 

Preparations 
Lactic Acid 0.3-2.0 c.c. m. v-xxx 

(Acidum Lacticum) 

This contains 75% of pure lactic acid. 

OXALIC ACID 

Oxalic acid is an organic acid, found in sorrel and other 
vegetable substances. It is never used as a medicine, but 
potassium oxalate, or essential salt of lemon, and oxalic acid 
are frequently used to clean metal kitchen utensils. These 
salts resemble epsom salts in appearance, and are a frequent 
cause of severe poisoning, when taken by mistake, or with 
suicidal intent. The symptoms are due to the removal of 
calcium from the blood and tissues, because the oxahc acid 
readily combines with it. 

Oxalic Acid Poisoning 

The symptoms usually appear in a few minutes: 

1. Severe burning pain in the mouth or throat. 

2. Intense cramp-hke abdominal pain. 

3. Profuse vomiting, the vomited matter containing 
mucus, pieces of mucous membrane and blood. 

4. Muscular weakness and twitchings of the muscles. 

5. Occasionally convulsions. 

6. Collapse (rapid, irregular, weak, thready pulse, slow shal- 
low breathing, cyanosis, cold moist skin, coma and death). 

The patient may die in a few minutes from collapse; or in 
a few weeks from starvation or from nephritis, as a result of 
the injury to the stomach, intestines and kidneys. 30.0 gms. 
or Si of oxahc acid usually prove fatal; though death has 
occurred from as httle as 4.0 gms. (si). 

Treatment 

1. Neutrahze the oxalic acid at once with an alkah, such 
as calcium. Lime water, chalk or the plaster from the wall 
may be used for this purpose. 



114 MATERIA MEDICA 

Do not give any preparation of sodium or potassium, as 
these form poisonous substances with the oxahc acid. 

2. Give emetics. 

3. Protect the mucous membranes : with egg albumin, 
milk, etc. 

4. The collapse is treated with heart stimulants, such as 
strychnine, caffeine, digitalis, etc. 

Other organic acids occasionally used are: 

Hydrocyanic Acid 
Tannic Acid 
Gallic Acid 

These are considered under their more important actions 
for which they are principally used. 



ALKALIES AND ALKALINE EARTHS 

The following drugs are used principally to neutralize 
acids and are therefore often called antacids. 

An alkali is a substance which belongs to a group of 
chemical substances called bases. Alkalies combine with 
acids to form salts. They dissolve proteins, forming protein 
combinations which act like salts. They also combine with 
fats to form soaps. 

The substances commonly used as alkalies are the salts 
of the following elements : 

Sodium 

Potassium 

Ammonium 

The alkaline earths are the following elements and their 
salts : 

Calcium 

Magnesium 

Lithium 

ACTION 

Local action : Weak solutions of alkalies make the skin feel 
soft and soapy, by dissolving the superficial epidermis, or 
horny layer of the skin. Concentrated solutions destroy 
the skin and underlying tissues, forming a soft crust, which 
soon falls off, leaving an ulcer. Mucous membranes are 
affected in the same way as the skin. Alkalies and their 
salts readily dissolve mucus. 

Internal Action 

Sodium Bicarbonate is the preparation commonly given 
internally. 

In the mouth: The alkalies have a characteristic alkahne 
taste. 

They dissolve the mucous secretions, redden and soften 
the lining membrane of the mouth and tongue and make the 
mouth feel soapy. 

115 



116 MATERIA MEDICA 

In the stomach : They neutralize and lessen the formation 
of the acid in the stomach by combining with the acid to 
form salts. 

In the intestines : The alkalies enter the intestines as salts 
which have been formed in the stomach. They withdraw 
fluid into the intestines from the blood and tissues, which 
then distends the intestines and causes frequent movements 
of the bowels. They also dissolve the mucus in the intestine. 

Action after Absorption 

Some of the salts of various alkalies or those formed in 
the stomach are readily absorbed into the blood. These 
salts make the blood more alkaline in reaction, and thereby 
reheve various conditions due to diminished alkaline salts in 
the blood (acidosis) . They have no selective action on any of 
the organs of the body. 

Excretion 

The alkahes and their salts are excreted mainly by the 
kidneys, increasing the flow of urine at the same time. They 
lessen the acidity of the urine or make it alkaline in reaction. 
They are also shghtly excreted by the mucous membranes. 

Poisonous Effects of Alkalies 

Acute poisoning frequently results from some of the 
alkalies when they are taken by mistake. Washing soda, 
lye, or sodium carbonate is conamonly used for cleaning 
purposes. It is found in every household, and if carelessly 
left around the house, it is occasionally taken by children, 
producing very serious symptoms. 

Symptoms 

The symptoms usually appear in a few minutes after the 
alkali has been taken : 

1. The tissues about the lips and mouth are destroyed and 
covered with a swollen white crust, and there are pieces of 
bloody moist shreds of tissue around the lips and mouth. 

2. Severe abdominal pains. 

3. Profuse vomiting. The vomited matter contains pieces 
of mucous membrane and blood. 



ACIDS AND ALKALIES 117 

4. Occasionally there is diarrhoea, the stools containing 
blood and pieces of mucous membrane. 

5. Collapse (rapid thready pulse, slow shallow breathing, 
cold moist skin, and dilated pupils). 

The patient may die of collapse, or occasionally from a 
perforation of the stomach wall, resulting from the destruc- 
tive action of the alkaH. 

If the patient recovers from the acute symptoms, the scars 
which form at the areas in the oesophagus and stomach where 
the tissue was destroyed, make these organs narrower 
(stenosis). This condition may necessitate radical surgical 
treatment. 

Treatment 

1. Give as an antidote, a dilute vegetable acid such as 
lemon juice, vinegar or dilute acetic acid. 

2. Protect the mucous membrane by egg albumin, oils 
or milk. 

3. The collapse is treated with heart stimulants; such as 
caffeine, strychnine, atropine, digitalis, etc., and the patient 
should be kept warm. 

Do not wash out the stomach, since passing a stomach tube 
may cause a perforation of the stomach. 

Uses of the Alkalies 

The alkalies are principally used for the following con- 
ditions : 

1. To neutralize the acid in the stomach, in hyperacidity, 
a condition where there is too much acid secreted in the 
stomach. It is also given in ulcer of the stomach. In this 
condition pain is due to the excessive amount of acid formed 
in the stomach, which is neutralized by the alkalies. In 
these cases the alkalies are best given about a half to one 
hour after meals, v/hen the stomach contains the largest 
amount of acid. 

2. They are also used to dissolve mucus and other secre- 
tions. 

3. To increase the alkaline salts in the blood in cases of 
diabetic coma and other similar conditions due to excessive 
formation of acids in the body (acidosis). 



118 MATERIA MEDICA 

Administration 

To neutralize acids, alkalies should be given after meals, 
only slightly diluted to lessen absorption. 

To increase the alkahne reaction of the blood they should 
be given between meals in large quantities of water to in- 
crease absorption. 

In cases of coma they may be given intravenously or by 
rectum in the form of a Rectoclysis. 

PREPARATIONS OF THE ALKALIES 

SODIUM COMPOUNDS 

Sodium is a metallic element. It is found in nature in 
various forms: 

1. As sodium chloride or salt, in salt mines, or obtamed 
from sea water by evaporation. 

2. In Chili it is found as sodium nitrate. 

3. As borax or sodium borate in various parts of the 

world. 

Preparations 

Sodium Hydroxide 

(Sodii Hydroxidum) 

(Caustic Soda) 

This comes in white sticks, which readily take up moisture 
from the air. It is occasionally applied as a caustic, to 
destroy tissue. It often causes severe injury to the tissues. 

Solution of Sodium Hydroxide 1.0-4.0 c.c. m. xv-5i 

(Liquor Sodii Hydroxidi) 

This is a 5% solution of sodium hydroxide in water. 

Monohydrated Sodium Carbonate 0.3-2.0 gms. grs. v-xxx 
(Sodii Carbonas Monohydratus) 

Sodium Carbonate 0.3-2.0 gms. grs. v-xxx 

(Sodii Carbonas) 

(Washing Soda) 

These two preparations are rarely used internally. Ex- 
ternally they are used to dissolve mucus and other secretions. 
They are frequently used to clean glass, china, woodwork, 
etc. They frequently cause poisonous symptoms when taken 
by mistake. 



ACIDS AND ALKALIES 119 



SODIUM BICARBONATE 

Sodium bicarbonate is the most commonly used alkali. 
When applied locally in solutions it dissolves crusts and 
secretions resulting from inflammations. Applied to mucus 
membranes it dissolves mucous and inflammatory secretions. 

Internally, it neutralizes the hydrochloric acid in the 
stomach by combining chemically with it forming sodium 
chloride. It also checks fermentation, neutralizes the or- 
ganic acids formed in the stomach by fermentation, and 
dissolves mucous. By neutralizing the excessive acid in the 
stomach it lessens spasm at the pylorus of the stomach. 

Sodium bicarbonate is absorbed into the blood stream as 
sodium chloride. Consequently it increases the sodium ions 
in the blood and it thus increases the alkalinity of the blood. 

Uses 

Locally, solutions of sodium bicarbonate are applied to 
burns, eczema, and other skin diseases, as a soothing ap- 
plication to dissolve crusts and secretions. It forms an im- 
portant ingredient of most mouth washes, gargles and tooth 
pastes, because of its ability to dissolve mucus. 

Internally it is used principally in conditions of hyper- 
acidity and ulcer of the stomach, for the purpose of neutral- 
izing the excess of acid. It therefore lessens the pain pro- 
duced by the spasm at the pylorus, which results from the 
excess of acid. It is also given to check nausea and vomiting 
and fermentation in the stomach even when no excess of 
hydrochloric acid is evident. 

Sodium bicarbonate is extensively used for the treatment 
of the condition known as Acidosis. This is a group of 
symptoms due to the fact that the alkaline reaction of the 
blood is diminished by the presence in the blood of various 
acids such as acetone, diacetic acid and oxybutyric acid, 
which are formed from the tissues. When these acids are 
present in the blood in excess they also appear in the urine 
and can be recognized on the examination of the urine. A 
normal alkaline reaction of the blood is essential to life and 



120 MATERIA MEDICA 

when the alkaUnity is diminished the symptoms of acidosis 
occur. Acidosis occurs in diabetes, delayed chloroform 
poisoning, uremia and starvation. The symptoms occur 
gradually and consist principally of headache, vomiting, a 
peculiar type of breathing, and finally coma and death. 

Acidosis is treated by giving the patient large doses of 
sodium bicarbonate so as to increase the alkaline condition 
of the blood by neutrahzing the excess of acid substances 
in the blood. 

Administration 

Locally sodium bicarbonate is applied in solutions of 
various strengths usually combined with other remedies. In 
stomach cases when it is given for excessive acid, it should 
be given in vichy, seltzer or vv'arm water. Frequently it is 
given in capsules or powders combined wdth other alkalies 
such as bismuth or magnesia. For gaseous distention (flatu- 
lence) it should be given before or between meals in a tum- 
blerful of vichy, seltzer or warm water. 

In acidosis sodium bicarbonate is given by mouth, by 
rectum or intravenously^ In mild cases it is given by mouth 
in doses of 0.6-1.0 gm. (grs. x-xv) three times a day. In the 
severe cases about 4.0 gms. (5i) is given three times a day, 
or by rectum in 3-5% solutions by the Murphy or Recto- 
clysis method. In the very severe cases the sodium bicar- 
bonate is given intravenously in 3-5% solutions about 500 
c. c. at a time. Sodium Bicarbonate produces effects in 
acidosis only if it is given in very large doses. 

Soditim Bicarbonate 0.3-2.0 gms. grs. v-xx 

(Sodii Bicarbonas) 

Troches of Sodium Bicarbonate 
(Troschisci Sodii Bicarbonatis) 

There are numerous other preparations which contain 
sodium bicarbonate, such as seidlitz powder; but these are 
used principally as cathartics. 



ACIDS AND ALKALIES 121 



POTASSIUM COMPOUNDS 

The salts of potassium act like the sodium compounds 
with the following variations in their effects: 

1. Concentrated solutions, such as potassium hydroxide, 
have a greater destructive action on the skin. They destroy 
the skin and underlying tissues, causing an ulcer when the 
resulting crust falls off. 

2. The salts of potassium when absorbed into the blood, 
slightly w^eaken and slow the contractions of the heart. 

3. They increase the flow of urine more than the sodium 
compounds. 

The potassium salts are very rarely used as alkalies. 



Preparations 



Potassium Hydroxide 
(Potassi Hydroxidum) 

(Caustic Potash) 



This comes in white sticks which take up moisture from 
the air. It is used principally as a caustic, to destroy tissues. 
When this is applied locally, the surrounding tissues about 
the spot to be cauterized, should be well protected owing to 
its violent action. 



Solution of Potassium Hydroxide 0.6-2.0 c.c. m. x-xxx 
(Liquor Potassii Hydroxidi) 



This contains 5% of potassium hydroxide. 



Potassium Carbonate 0.3-2.0 gms. grs. v-xxx 

(Potassii Carbonas) 



122 MATERIA MEDIC A 

Potassium Bicarbonate 0.3-2.0 gms. grs. v-xxx 

(Potassii Bicarbonas) (saleratus) 



Potash and Lime 
(Potassa cum Calce) 

This is known as Vienna paste, and consists of equal parts 
of potash and quickhme and is used locally as a caustic. 

Various salts of ammonium are used as alkalies or ant- 
acids. Their action has been described under their other 
more important effects. 



ALKALINE EARTHS 

The most common alkaline earths used in medicine are 
the salts of calcium and magnesium. These salts differ from 
the alkalies in being very insoluble. They are therefore not 
readily absorbed, and produce only a local effect in the 
stomach and intestines. 



CALX OR CALCIUM (LIME) 

Calcium salts are found very abundantly in nature. They 
are found in large quantities in all the tissues of animals. 
Calcium phosphate is found in the bones and teeth of all 
animals, as well as in many of the soft tissues. Calcium 
salts are necessary for the activity of many forms of living 
matter. 

Many mineral substances contain large quantities of cal- 
cium salts. Thus, calcium carbonate is found in chalk, 
marble and limestone. Calcium sulphate is found in plaster 
of paris, gypsum and alabaster. 

Calcium preparations are used to clean teeth, and form, 
therefore, an ingredient of most tooth powders or pastes. 



ACIDS AND ALKALIES 123 

ACTION 

Local actions The calcium salts have no effect on the skin. 
Calx or unslaked lime however, burns and destroys tissues 
if applied to mucous membranes. 

Internal Action 

In the mouth: The calcium salts contract the mucous 
membranes. 

In the stomach: They neutralize the acid, lessen digestion 
and contract and soothe the mucous membranes. 

In the intestines: They contract and soothe the mucous 
membrane (astringent action). 

Action after Absorption 

The calcium salts are very slowly absorbed from the 
stomach and intestines. Part of these salts are absorbed 
into the blood, however, and help to form fibrin ferment, so 
that the blood clots better. 

In diseases where there is an insufficient amount of calcium 
or lime in the body, such as rickets, the bones become 
softened and are often deformed. The calcium absorbed 
from the blood is then deposited in the bones and hardens 
them. 

Calcium is also necessary for the nutrition of nerve tissues. 
Many nervous conditions characterized by twitching of the 
muscles are beheved to be due to a deficiency of calcium in 
the body. 

Excretion 

The calcium salts are excreted mostly by the large intes- 
tine and kidneys. 

Poisonous Eftects 

Poisoning from lime occasionally occurs when unslaked 
hme is swallowed. The symptoms are the same as those of 
poisoning by other alkalies. 

Slaked lime occasionally causes severe destruction of the 



124 MATERIA MEDICA 

tissues. Laborers who handle Hme, occasionally get some of 
it into the eye. Severe destruction of the eye, even loss of 
sight, may then result. When this happens the eye should 
immediately be thoroughly washed out with a solution of 
boric acid. 

Uses 

Solutions of calcium are used locally to soothe the skin in 
burns. Internally, calcium is used to neutraUze the acid in 
the stomach, in hyperacidity, to lessen nausea and vomiting, 
and in ulcer of the stomach. 

When given to neutrahze the acid, it is best given about a 
half to one hour after meals, when the stomach contains the 
largest amount of acid. Calcium preparations are also used 
as antidotes for poisoning by acids. 

Calcium salts are frequently given in nervous conditions 
characterized by excitability, such as epilepsy, tetany, etc. 

Preparations 

For Internal Use 

Lime Water 30.0-120.0 c.c. gi-iv 

Solution of Calcium Hydrate 
(Liquor Calcis) 

This is a saturated solution of calcium hydrate or slaked 
lime, containing 0.17 gm. of calcium hydrate to 100.0 c.c. of 
water, or gr. ^-f to §i of water. 

It is made by washing slaked lime with distilled water, 
and then filtering the resulting solution. 

It is used to neutralize the acid in the stomach, to soothe 
the stomach and to lessen nausea and vomiting. It is very 
constipating. 

When added to milk, it lessens curdling in the stomach 
and makes the milk more digestible. 

Syrup of Lime 1.0-4.0 c.c. m. xv-5i 

Syrup of Calcium Hydroxide 
(Syrupus Calcis) 

This contains 5% of lime. 



ACIDS AND ALKALIES 125 

Calcium Chloride 0.3-1.0 gm. grs. v-xv 

(Calcii Chloridum) (well diluted) 

This is used to increase the clotting of the blood. It is 
somewhat injurious to the tissues however. When fresh it is 
a good antiseptic, §vi of the calcium chloride being used to 
a gallon of water. 



Calcium Lactate (not official) 0.2-0.6 gm. grs. iii-x 
(Calcii Lactas) 

This is used principally to increase the clotting of the 
blood in haemorrhage. It is frequently given for several 
days before tonsil and adenoid operations to prevent profuse 
bleeding. It is occasionally given hypodermically. 

For Local Use 
Lime Liniment 
(Linimentum Calcis) 
Carron Oil 

This is a mixture of lime water and olive or linseed oil in 
equal parts. 



Unslaked Lime 
Calx 

This is made from limestone. It forms a white mass 
which cracks and changes to a powder, when placed in water, 
forming slaked lime and liberating heat. 

It is used as a disinfectant and to destroy tissue (caustic) . 

For this purpose it is used together with potassium in 
the form of vienna paste or potassa cum calce. 



Milk and Lime (non-official) 
Whitewash 

This is made by adding 1 part of slaked lime to 4 parts of 
water. It is used as a disinfectant, especially for typhoid 
and cholera stools, It is also a soothing application for 
burns. 



126 MATERIA MEDICA 

Chalk Mixture 15.0-30.0 c.c. §i-i 

(Mistura Cretae) 

This contains 20 gms. chalk suspended in 100 c.c. of 
water. 

MAGNESIA 

The preparations of magnesia act similarly to those of cal- 
cium. 

1. They neutralize the acid in the stomach. 

2. They are not readily absorbed^ passing into the intes^ 
tines, where they act as cathartics, causing frequent fluid 
stools. 

3. The small amount of magnesia that is absorbed, in- 
creases the alkaline reaction of the blood. It is excreted 
by the urine, which it increases in amount, lessens its acid- 
ity or makes it alkaline in reaction. 

Preparations 

The preparations of magnesia, which are principally used 
to neutralize the acid in the stomach, are : 

Magnesium Oxide 0.3-4.0 gms. grs. v-3i 

(Magnesii Oxidum) 

(Calcined or light magnesia) 

(The Magnesia Usta of the German Pharmacopoeia) 

Milk of Magnesia 4.0-16.0 c. c. 5i-Bi 

This is a proprietary preparation containing magnesium 
hydrate. It is used as an antacid and cathartic. 

The other preparations of magnesia are principally used 
as cathartics, under which group they are described. 

LITHIUM 

The salts of lithium are also alkaline in reaction and 
neutralize the acid in the stomach. They are principally 
used as diuretics and are described in that group. 



CHAPTER VII 

DIGESTANTS 

In cases where the stomach secretes very Uttle gastric 
juice, or where the secretion of other digestive juices is 
diminished, the patient is unable to digest food. 

In such cases the digestion of the food can be assisted 
by giving various ferments which digest the food substances : 
proteins, carbohydrates and fats. These ferments replace 
the gastric or intestinal juices which may be very much 
diminished or absent. 

Substances Used for Digestion of Carbohydrates 

Carbohydrates are starchy foods, such as bread, potatoes, 
and sugars. 

The starchy foods are partially digested in the mouth. 
They are changed to sugars by the saliva, which contains a 
ferment, ptyalin. The digestion of the starchy foods and 
sugars is completed in the intestines, by the pancreatic 
juice, which contains the starch digesting ferment, amylopsin, 
and by the intestinal juice which contains invertin. This 
ferment completes the digestion of the sugars. 

Malt 

Malt is barley grain which has been made to grow artifi- 
cially. The growth is then stopped by means of heat. 

During this growth the starch contained in the barley, 
is changed to sugar by means of diastase, a ferment which is 
contained in the barley grain. 

Malt which contains this ferment, diastase, is often given 

to help the digestion of starch. Many of the preparations 

used, contain no diastase and produce no digestive effects; 

though they are easily digested foods. Many of the malt 

extracts contain alcohol, and are therefore similar to beer 

or stout. 

127 



128 MATERIA MEDICA 

Preparations 

Extract of Malt 16.0 gms. 3iv 

(Extractum Malti) 

This is an extract of malt in syrup. 

Unofficial Preparations 
Maltine 
Maltzyme and others 

Taka Diatase 

This is a starch digesting ferment formed by the action 
of a mould (Eurotium oryzae) upon wheat bran. It is 
named after its discoverer, Takamine, a Japanese. 

Taka diastase is very powerful and efficient, but it only 
acts in the stomach before the normal amount of acid is 
secreted. The action of starch digesting ferments is usually 
destroyed by the acid in the stomach. 

Substances Used for the Digestion of Proteins 

Proteins are food substances such as meat and eggs. 
Milk also contains a large percentage of proteins. 

The proteins are partially digested by the gastric juice, 
which consists mainly of pepsin and hydrochloric acid. 
Pepsin can act only in the presence of an acid. Proteins are 
completely digested by the pancreatic and intestinal juices. 
The pancreatic juice contains trypsin, a ferment which 
digests proteins completely; amylopsin, a ferment which 
digests starches completely; and steapsin, a ferment which 
breaks up the fats into very small globules (emulsifies). 

Pancreatic juice can act only in the presence of an al- 
kali, but is destroyed by an acid, such as the acid in the 
stomach. 

The intestinal juice contains erepsin, a ferment which com- 
pletes the digestion of the proteins. 

PEPSIN 

Pepsin is a ferment obtained from the lining m.embrane 
of fresh stomachs of healthy pigs. It is used to aid di- 



DIGESTANTS 129 

gestion in cases where the pepsin of the gastric juice is 
diminished. 

Pepsin acts only in the presence of an acid; it should 
therefore always be given with dilute hydrochloric acid. 
Alkalies destroy its activity; it should therefore never be 
given with such substances as sodium bicarbonate. 

Preparations 

Pepsin 0.3-0.6 gm. grs. v-x 

(Pepsinum) 

The following unofficial preparations are often used: 
Essence of Pepsin 8.0 c.c. 5ii 

(Essentia Pepsini) 

Glycerite of Pepsin 3.0 c.c. m. xlv 

(Glyceritum Pepsinae) 

The elixir of pepsin and pepsin solution are other preparations. 

New and Non-official Preparations 
Elixir of Enzymes 4.0-8.0 5i-ii 

This is a solution containing pepsin and rennet in 20% of 
alcohol. 

Rennet 

Rennet is a ferment secreted by the mucous membrane 
of the stomach. It curdles milk. 

Pegnin 

Milk Sugar Rennet 

About 8.0-10.0 gms. (5ii-iiss) of pegnin are added to 
1000 c.c. of cool boiled milk. The mixture is then allowed 
to stand for two or three minutes, and is then shaken so 
as to divide the clot into fine particles, and give it a uni- 
form consistency. 

PANCREATIN 

Pancreatin is a mixture of all the ferments obtained from 
the fresh pancreatic glands of the pig. It is used principally 
to predigest foods, before they are given to the patient, in 
cases where the patient himself is unable to digest food. 



130 MATERIA MEDICA 

Pancreatin can act only in the presence of an alkali, and 
must always be given with sodium bicarbonate. It is seldom 
given internally, as it is destroyed by the hydrochloric acid 
in the stomach. 

When it is given internally, it should be given in pills 
coated with keratin, a substance which the acid of the 
gastric juice does not affect, but which is dissolved by the 
alkahne intestinal juices. 

Preparations 

Pancreatin 0.1-0.3 gm. grs. ii-v 

(Pancreatinum) 

Unofficial Preparations 

Peptonizing Powder 

(Pulvis Pancreaticus Compo situs) 

This is used to predigest foods such as milk and eggs. 
Each powder consists of 5 grains of pancreatic extract, 
and 15 grains of sodium bicarbonate. 

METHOD OF PEPTONIZING MILK 

Partially Peptonized Milk: 

To a bottle containing one pint of milk and 4 ounces of 
water, add one peptonizing powder. Keep the bottle at a 
temperature of 105 to 115° (Fahrenheit). This is best done 
by placing the bottle in hot water of that temperature, for 
about 20 minutes to a half hour. The milk should then have 
a shghtly bitter taste. Part of the proteins of the milk are 
digested by this method. 

Completely Peptonized Milk : 

The method for complete peptonization is the same as 
for partial peptonization, but it is continued for two hours, 
during which time all the proteins are completely digested. 
Completely peptonized milk has an extremely bitter taste. 

Diazyme Essence 4.0-8.0 c.c. oi-ii 

This is a liquid containing all the amylopsin of the pan- 



DIGESTANTS 131 

creas. It is used to digest starchy foods, when these are not 
readily digested by the sahva or pancreatic juice. 

Diazyme Glycerole 4,0-8.0 c.c. 5i-ii 

This acts hke the diazyme essence. 
Glycerole Trypsin: By mouth 4.0-8.0 c.c. 5i-ii 

Hypodermically 0.3 c. c. (m. v.) every other day. 

This preparation is given by mouth, or hypodermically 
for the treatment of cancer. It is supposed to digest the 
cancer cells. 

Holadin : One capsule, three hours after meals. Each capsule 
(Extractum Pancreaticum Integrum) contains 0.2 gm. grs. iii 

This is an extract of the pancreatic glands which contains 
all the enzymes: trypsin, amylopsin and steapsin; and a 
milk curdling ferment. It is used in diseases where the food 
is not well digested. 
Panase 0.12-0.3 gm. grs. ii-v 

This is a combination of the digestive ferments of the 
pancreas, derived from the pancreatic gland of the pig; It 
is used where digestion is poor. 

Pankreon 0.25-1.0 gm. grs. iv-xv 

Tannin Pancreatin Compound 0.06-0.25 gm. grs. i-iv for children 

This is a mixture containing the trypsin, amylopsin and 
steapsin of the pancreatic juice, and about 8% of tannin. 

It acts in the intestines, aiding digestion in diseases where 
the food is not thoroughly digested, because of lessened 
secretion of the pancreas. It is also used in diarrhoea, dys- 
entery, marasmus, etc. 
Trypsin 0.12-0.3 gm. grs. ii-v 

This is the protein digesting ferment of the pancreas. 

It is applied in solutions containing sodium bicarbonate, 
to diphtheritic, or other membranes. It is also given hypo- 
dermically, in cases of cancer, to digest the cancer cells. 

Ingluvin (Not official) 0.3-1.0 gm. grs. v-xv 

Ingluvin is the extract of a fowl's gizzard, and is occasion- 
ally used to aid in the digestion of proteins. 



132 MATERIA MEDICA 

Papain 

Papain is the fruit of the Carica papaya, a tree growing in 
tropical countries. The juice of this fruit contains a fer- 
ment, papain, papayotin or papoid which is used to aid the 
digestion of proteins. 



CHAPTER VIII 

CARMINATIVES ANE 

(Gastric Stimulants) 

BITTERS 

Bitters are vegetable drugs which increase the activity of 
the secretory function of the stomach, but produce no effects 
after absorption. 

There are two kinds of bitters : Simple and Aromatic. 

Simple bitters are vegetable substances which increase 
the activity of the stomach, and improve the appetite. 

Aromatic bitters are vegetable substances used as bitters, 
which have a pleasant odor because of volatile oils which 
they contain. 

There are other drugs which cause important effects 
after absorption, but which may also act as bitters in the 
stomach; for example, nux vomica and quinine. Many sub- 
stances used as condiments with food, produce the same 
effect. 

Action 

Simple bitters have no local action on the skin. 

When taken internally, they increase the appetite, and the 
secretion of gastric juice. The patient therefore eats more, 
and digests his food better. If they are taken for a long time, 
he gains in weight, feels better, and is generally more robust, 
healthier and stronger. 

Poisonous Effects 

Occasionally, some of the bitters, such as quassia and 
berberis, if given in large quantities, may cause diarrhoea, 
frequent urination, nausea, vomiting, restlessness, and a rapid 

133 



134 MATERIA MEDICA 

weak pulse. These symptoms are due to the alkaloids 
quassin and berberine which they contain. 

Administration 

Bitters should always be given before meals in fluid form. 
They should be given undiluted and their taste should not be 
disguised as this may interfere with their effect. 

SIMPLE BITTERS AND THEIR PREPARATIONS 

GENTIAN : The root of the Gentiana lutea, or the yellow 
gentian of the Alps. 

Extract of Gentian 0.1-0.6 gm. grs. ii-x 

(Extractum Gentianae) 

Compound Tincture of Gentian 2.0-16.0 c.c. 3i-iv 

(Tinctura Gentianae Composita) 

Gentian is often used as a mild laxative. 

CALUMBA: The root of Jateorrhiza palmata, a climbing 
vine which grows in Mozambique. 

Tincture of Calumba 4.0-15.0 c.c. 5i-iv 

(Tinctura Calumbae) 

Calumba is often used in the treatment of thread worms. 

CHIRATA: The herb and root of Swertia chirata, a plant 
growing in the northern part of India. 

Fluidextract of Chirata 0.3-1.0 c.c. m. v.-xv 

(Fluidextractum Chiratae) 

BERBERIS: Barberry, a drug obtained from the root and 
berries of Berberis vulgaris, which grows in Europe. It con- 
tains an active principle, berberine, an alkaloid, and some 
tannin, which makes it contract mucous membrane slightly, 

Fluidextract of Berberis 2.0 c.c. m. xxx 

(Fluidextractum Berberidis) 

QUASSIA: A drug obtained from the wood of Picraena 
excelsa, a large tree which grows in Jamaica. It contains 
an active principle quassin. 



BITTERS, CARMINATIVES AND EMETICS 135 

Fluidextract of Quassia 0.3 -2.0 c.c. m. v-xxx 

(Fluidextractum Quassiae) 

Tincture of Quassia 1.0 -4.0 c.c. m. xv-3i 

(Tinctura Quassiae) 

Quassin (not official) 0.015-0.03 gm. grs. |-J 

A 10% infusion of quassia is given as an enema for round 
worms in children. 

TARAXACUM: Taraxacum is obtained from the root of 
the Taraxacum officinale, or ordinary dandelion. 

It acts as a simple bitter and laxative. It also increases 
the flow of urine. 

Preparations 

Extract of Taraxacum 0.3-1.0 gm. grs. v-xv 

(Extractum Taraxaci) 

Fluidextract of Taraxacum 4.0-8.0 c.c. 3i-ii 

(Fluidextractum Taraxaci) 



OTHER SUBSTANCES USED AS BITTERS 
CONDURANGO : The bark of the condurango tree. 

PAREIRA: The root of the Chondodendron tomentosum, 
a climbing plant of South America. 

NUX VOMICA, CINCHONA, and their alkaloids, strych- 
nine and quinine are also used as simple bitters, but their 
general effects are more important; under which they will be 
considered. 

CETRARIN: 0.06-0.2 gm. grs. i-iii 

This is a bitter principle obtained from Iceland moss. It 
is said to increase peristalsis, and the secretion of sahva, 
bile and pancreatic juice. 

OREXIN: This is an artificial chemical substance used as 
a bitter. It must not be given on an empty stomach, as it 
is somewhat injurious to the stomach. 



136 MATERIA MEDICA 



AROMATIC BITTERS 



The aromatic bitters increase the secretion of the lining 
membrane of the stomach more than the simple bitters do, 
on account of the volatile oils which they contain. Their 
effects are also more lasting, and they contract the mucous 
membranes, because of small quantities of tannic acid which 
many of them contain. 

They should always be given before meals, best in fluid 
form undiluted, and their taste should not be disguised. 

Aromatic Bitters and Their Preparations 

SERPENT ARIA: The root of the Virginia snake root, a 
small herb, which grows in the United States. This is often 
combined with other bitters. 

Tincture of Serpentaria 2.0-8.0 c.c. 3 J-ii 

(Tinctura Serpentariae) 

OTHER SUBSTANCES USED AS AROMATIC BITTERS 

Aurantii Dulcis Cortex (Sweet Orange Peel) 

Aurantii Amari Cortex (Bitter Orange Peel) 

Anthemis, Chamomile: The dried flowers of Anthemis 
nobilis, a European plant. 

Matricaria, German chamomile: The flowers of Matricaria, 
chamomilla, German plant. 

Eupatorium: The leaves and flowering tops of boneset, or 
thoroughwort. 

Eucalpytus : The leaves of the blue gum tree of Austrahao 



BITTERS, CARMINATIVES AND EMETICS 137 

CARMINATIVES 

The following drugs are used principally to check the 
formation, and aid the expulsion of gas from the stomach 
and intestines. A drug which has such an action is called a 
carminative. The carminatives usually contain volatile oils, 
and most of them also act as aromatic bitters. They are 
occasionally used to check the griping pains often caused 
by cathartics. Because of the pleasant odorous oils which 
many of them contain, they are used to disguise the taste of 
unpleasant tasting drugs. Some of them are used as con- 
diments with food. 

Action 

Local Action: Applied to the skin, they act as antiseptics ;_ 
and in strong solutions, they cause redness, pain and swelling, 
and in strong preparations they may even cause blisters. 

On mucous membranes, they cause redness and swelling, 
slight pain and smarting, with excessive secretion of mucus. 

Internal Action 

In the mouth, they produce a hot burning taste, and in 
large doses they cause redness of the lining membrane of 
the mouth, and an increased flow of saliva, which aids in 
the digestion of the food. At the same time they have a 
very pleasant aroma, and their antiseptic action is again 
manifested. 

In the stomach and intestines, they cause a feeling of 
warmth, and a sense of comfort, and they relieve the feeling 
of distention after meals. 

By their antiseptic action, they lessen the formation of 
gas, and by causing redness and swelling (irritation), of 
the lining membrane, they bring about contractions of the 
muscle wall of the stomach and intestines, and help to ex- 
pel gas. 

Many of the carminatives increase the appetite, and 
probably by their pleasant aroma, as well as by directly 
activating the lining membrane of the stomach and intes- 
tines, they increase the secretion of the digestive juices, and 
aid in the digestion of food. 



138 MATERIA MEDICA 

Action after Absorption 

Occasionally, some carminatives may cause effects after 
absorption (see preparations below). 

Excretion 

The carminatives are mostly excreted by the expired air 
and the urine, part of the drug being used up in the body, 
however. 

In their passage through the lungs, they increase the flow 
of bronchial secretion, thereby increasuig expectoration, 
and in their passage through the kidneys, they may increase 
the flow of urine (diuretic action). 

Some drugs in the carminative group are given for these 
effects. 

Carminatives and Their Preparations 

CAPSICUM, Cayenne Pepper: The extremely pungent 
fruit of the Capsicum fastigiatum, or African pepper. 

Capsicum causes marked redness and blistering of the 
skin, often destruction of the area of skin over which it is 
applied. 

Internal Action 

In large doses it often causes violent pain in the abdo« 
men, with vomiting, followed by profuse diarrhoea and very 
painful urination. 

Uses 

Capsicum is used to increase the secretion of the stomach, 
particularly in patients suffering from chronic alcoholism. In 
such patients the Hning membrane of the stomach is so af- 
fected that it secretes very little gastric juice. 

It is also used in the form of a plaster to produce bhsters, 
in order to draw fluid from deeper tissues into the skin. 

Tincture of Capsicum 2.0-4.0 c.c. m. xxx-3i 

(Tinctura Capsici) 

Capsicum Plaster For local use 

(Emplastrum Capsici) 

ZINGIBER, Ginger: The dried roots of the Zingiber 
officinale, which grows in the East and West Indies. Green 



BITTERS, CARMINATIVES AND EMETICS 139 

ginger is the fresh, and black ginger, the dried roots. The 
fresher it is, the more active is the ginger. 

Tincture of Ginger 2.0-4.0 c.c. 3 ss-i 

(Tinctura Zingiberis) 

CARDAMOMUM, Cardamom: This is a drug obtained from 
the fruit of the Elettaria repens, which grows in the East 
Indies. 

Tincture of Cardamomum 2.0-4.0 c.c. m. xxx-5i 

(Tinctura Cardamom!) 2% 

Compound Tincture of Cardamom 4.0-8.0 c.c. 3i-ii 

(Tinctura Cardamom! Composita) 

ASAFOETIDA : This is a gum resin obtained by incising the 
root of the Ferula narthex, a plant which grows in Afghanis- 
tan in India. It consists of a gum resin and a volatile oil 
which is the active principle. Asafoetida is frequently used 
in India as a condiment. 

Action 

In the mouth: It has a very unpleasant nauseous taste, 
and an odor resembling garlic. 

In the stomach: It checks the formation and aids the ex- 
pulsion of gas (carminative action), and it increases the 
secretions. In the intestines: It increases the secretions 
and peristalsis and helps to expel gas. It causes frequent 
movements of the bowels. 

It is used principally to remove gas from the intestines. 
It is frequently given in an enema. 

Because of its unpleasant taste, which causes a psychical 
effect it is occasionally given to quiet hysterical patients. 

Preparations 

Emulsion of Asafoetida 15.0-30.0 c.c. § -|-i 

(Emulsum Asafoetidae) 

This is given by mouth, or in an enema; to relieve disten* 
tion. 

Tincture of Asafoetida 1.0-2.0 c.c. m. xv-xxx 

(Tincture Asafoetidae) 



140 MATERIA MEDICA 

Pills of Asafoetida 1 -3 pills 

(Pillulae Asafoetidae) 
Each pill contains 0.2 gm. (grs. iii) of asafoetida. 

Other Carminatives 

Chloroform water, Hoffman's anodyne (Compound spirits of 

ether), and a number of alcoholic preparations, such as 
curacoa, Cherrywater (kirschwasser) kummel, whiskey, rum, 
giup etc, are occasionally used as carminatives. 



EMETICS 

Drugs which Produce Vomiting 

Vomiting is an act whereby the stomach violently expels 
its contents. The strain of continued vomiting usually 
makes the patient very weak, and often produces symptoms 
of collapse. 

The patient is then very pale, his skin is cold and covered 
with perspiration, the pulse is rapid, weak and thready; 
his breathing is slow and shallow^, the pupils are dilated and 
the patient complains of great weakness. 

Physiology of Vomiting 

Drugs produce vomiting in two ways: 

1. By greatly increasing the activity of the lining mem- 
brane of the stomach (irritating), the muscular wall of the 
stomach contracts very forcibly, thus expelling the stomach 
contents. 

2. Some drugs cause vomiting after they are absorbed into 
the blood. These are carried by the circulation, to an area 
of gray matter in the medulla of the brain, whose function is 
to produce vomiting (the vomiting center), and cause this 
center to send impulses to the muscle wall of the stomach to 
contract, and thereby produce vomiting. 

IPECAC 

Ipecac is a drug obtained from the roots of the Cephaelis 
ipecacuanha, a wild plant growing in Brazil, Colombia and 
other parts of South America. 

Its active principles are the alkaloids : 

Emetine 

Cephaeline 

Psychotrine 

The vomiting is due principally to the cephaeline and 
partly to the emetine. 

141 



142 MATERIA MEDICA 

Appearance of the Patient 

If a patient is given a moderately large dose of one of 
the preparations of ipecac, a very short time after the ad- 
ministration he feels nauseated and vomits profusely. The 
vomiting is usually accompanied by profuse secretion of 
saliva, of tears, and of mucus from the bronchi. Occasion- 
ally, if the entke amount of drug is not completely excreted 
in the vomited matter, it may cause profuse diarrhoea 
and symptoms of mild collapse: rapid pulse, slower respira- 
tion, and cold moist skin. 

ACTION 

Local Action : On the skin ipecac produces redness, itching 
and small pustules. 

On the mucous membranes: On the eye it causes slight 
redness and swelling with a profuse flow of tears. In the nose 
it causes profuse secretion and continual sneezing. 

Internal Action 

In the mouth: It increases the flow of saliva. 

In the stomach: Ipecac acts principally on the lining 
membrane of the stomach, causing redness and swelling 
(irritation) with an excessive secretion. This causes the 
muscle wall of the stomach to contract violently, thereby 
producing vomiting. The vomiting continues, until all the 
ipecac in the stomach is entirely expelled. 

In the intestines: The action on the intestinal tract is 
similar to that in the stomach ; the lining membrane becomes 
red, swollen and secretes an excessive amount of mucus, 
thereby producing contractions of the muscle wall of the 
intestines which result in profuse diarrhoea. The stools often 
contain blood, from the excessive irritation. 

Action after Absorption 

Some of the ipecac is rapidly absorbed from the stomach. 
It then acts principally on all the mucous membranes. On 
the mucous membrane of the bronchi, it causes a profuse 



BITTERS, CARMINATIVES AND EMETICS 143 

secretion of mucus. (It is commonly given in cough mix- 
tures for this effect, especially to children, to increase expec- 
toration) . 

On the mucous membrane of the eye and nose it produces 
the same effects as when applied locally. It also increases the 
secretion of sweat. 

The symptoms of collapse, which occasionally result after 
large doses of ipecac, are usually due to the great strain of 
continual vomiting. 

Specific Action 

Ipecac is now used as a specific for Amoebic Dysentery 
and in Pyorrhoea alveolaris. The effect is due to the emetine, 
which destroys the amoeba, a single celled animal organism 
which is the cause of the former, and is found in the secretions 
of the latter disease. 

For its specific action ipecac should be given in keratin 
coated pills so as to avoid its action on the stomach and 
thereby to prevent vomiting. 

Excretion 

Ipecac is usually excreted by the stomach in the vomited 
matter, and does not therefore produce any poisonous symp- 
toms. 

Preparations 

Solid Preparations 

Powdered Ipecac, as emetic 2.0 gms. grs. xxx 

(Pulvis Ipecacuanhae) as expectorant 0.06-0.3 gms. grs. i-v 

Powdered Ipecac and Opium 0.3 -1.0 gm. grs. v-xv 

(Pulvis Ipecacuanhae et Opii) 

(Dover's powder) 

(Contains 10% opium and 10% ipecac) 

Fluid Prevarations 

Fluidextract of Ipecac, as emetic 1.0-2.0 c.c. m. xv-xxx 
(Fluidextractum Ipecacuanhae) 
as expectorant 0.2-0.5 c.c. m. iii-viii 

The following two preparations are given mostly to chil- 
dren. 



144 MATERIA MEDICA 

Syrup of Ipecac for infant as emetic 

(Syrupus Ipecacuanhae) 2.0-4.0 c.c. 5j-i 

(7% of fluidextract) as expectorant 

0.1-1.0 c.c. m. ii-xv 

Wine of Ipecac for a child as emetic 

(Vinum Ipecacuanhae) 2.0-4.0 c.c. 3j-i 

(10% of fluidextract) as expectorant 

0.1-1.0 c.c. m. ii-xv 

Active Principles 

Emetine Hydrochloride 0.02-0.06 gm. gr. |-i 

This has recently been used with brilliant results in the 
treatment of amoebic dysentery. It is given hypodermically 
in small doses and by mouth in the maximum dose. 

Administration 

If given to produce vomiting, it is best to dilute ipecac 
preparations in warm water. 

If given as an expectorant, especially to croupy children, 
the preparations should be given in syrup. 

APOMORPHINE 

Apomorphine is an artificial alkaloid, made from morphine, 
one of the alkaloids of opium. An acid is added to the mor- 
phine to take out some of its water, thus forming apo- 
morphine. (The process is called dehydration.) 

Appearance of the Patient 

When a moderate dose of apomorphine is administered 
hj^podermically, within ten to fifteen minutes after it is 
given, the patient feels nauseated and vomits profusely. At 
the same time, there is a profuse secretion of tears, of mucus 
from the nose and bronchi, and the skin is covered with cold 
perspiration. These symptoms are always produced by any 
drug which causes vomiting. There is usually a great deal of 
weakness after apomorphine is administered, at times very 
profound collapse: a rapid, thready pulse, slow and shallow 
respiration, cold perspiration and dilated pupils. The col- 
lapse has seldom been fatal^ however. 



BITTERS, CARMINATIVES AND EMETICS 145 

ACTION 

Apomorphine has no local action. 

Internally: Small doses often increase the secretions of all 
the mucous membranes without producing vomiting, and 
they are often given for this effect. 

Mode of action: Apomorphine produces vomiting, by 
causing the vomiting center in the brain to send impulses 
to the stomach to cause its muscle wall to contract and 
thereby expel its contents. 

Excretion: It is excreted by the stomach in the vomited 
matter. 

Preparations 



JL. 

1 



as emetic 
Apomorphine Hydrochloride, 0.005-0.012 gm. gr. 

(Apomorphinae Hydrochloridum) as expectorant 

0.002-0.004 gm. gr. 3V -iV 
Apomorphine is usually given hypodermically. 



MUSTARD 

This is frequently used to produce vomiting. About a 
teaspoonful to a tablespoonful of mustard is given in a glass 
of tepid water. The dose should be repeated in fifteen or 
twenty minutes if vomiting does not occur. 

ANTIMONY 

Antimony is a metal. Many of its preparations are used 
in medicine, principally to produce vomiting. 

ACTION 

Applied to the skin, antimony causes redness, and in strong 
solutions it produces blisters or pustules. 

When given internally, it causes profuse continuous vomit- 
ing and increases the secretions of all the mucous mem- 
branes and the sweat. On account of the collapse which 
follows its use, it is not often used. 



146 MATERIA MEDICA 

Overdoses usually cause profuse vomiting and diarrhoea, 
with profound collapse. 

Preparations 

Tartar Emetic, as a diaphoretic 

and expectorant 0.002-0.008 gm. gr. -^-| 

(Antimonii et Potasii Tartaras) 

as an emetic 0.03 -0.1 gm. grs. 4- - ii 

This preparation is also contained in the compound 
syrup of squills. 

Wine of Antimony, as a diaphoretic 0.6- 2.0 c.c. m.x-xxx 
(Vinum Antimonii) as an emetic 4.0-15.0 c.c. 5i-iv 

Contains 4 parts of Tartar Emetic to 1000. 

Other Drugs Used to Produce Vomiting 
Zinc Sulphate 0.6-2.0 gms. grs. x -xxx 

Copper Sulphate 0.2-0.3 gm. grs. iii-y 

Copper sulphate is the best emetic to use in cases oi 
Phosphorus poisoning. 

Alum 0.5 gm. grs. viii 

Alum is best given in molasses or in the syrup of ipecac. 

Turpeth Mineral (Yellow Mercurous Subsulphate) 
Hydrargyri Subsulphas Flavus 0.06-0.3 gm. grs. i-v 

(not official) 

This is given every ten or fifteen minutes until free 
vomiting occurs. 

Warm water given continuously will also cause vomiting. 

Salt (sodium chloride) is given in solid form or in concen- 
trated solutions to produce vomiting. 

Mustard is frequentl}^ used to produce vomiting. A 
teaspoonful to a tablespoonful of the mustard powder is 
given in tepid water, and is repeated in fifteen to twenty 
minutes if no effects were produced. 



CHAPTER IX 

CATHARTICS 

(Intestinal Stimulants) 

Cathartics are drugs which are used to move the bowels. 
Many drugs which produce various effects on the different 
organs of the body, may also increase the movements of the 
bowels, but the drugs here considered, are those which are 
used principally for this effect. 

Mode of Action 

Movements of the bowels are brought about by the con- 
tractions of the involuntary muscles of the intestines (per- 
istalsis). This is caused in the following ways: 

1. When the intestines fill up with solid, fluid or gaseous 
matter. This causes contractions of the intestinal muscles, 
thus producing movements of the bowels. 

2. When drugs cause redness and swelling of the mucous 
membrane of the intestines (irritation). This not only 
causes an increased secretion of mucus, which helps to fill up 
the intestines, but also affects the nerve endings in the wall 
of the intestines. Impulses are thus sent along the afferent 
nerve fibers to the spinal cord, which immediately sends 
back other impulses to the intestinal muscles to cause them 
to contract, and movements of the bowels result. (Such an 
action is called a reflex action). 

Frequent movements of the bowels are often accom- 
pa,nied by violent cramp-like pains in the abdomen (griping), 
due to contractions of the involuntary muscles of the in- 
testines which accompany such movements. 

To overcome the griping, many cathartics are often com- 
bined with other drugs which lessen intestinal peristalsis. 

For example — lapactic pills are very efficient commonly 
used cathartics. They contain the extract of belladonna 

147 



148 MATERIA MEDICA 

to overcome the griping which they might otherwise pro- 
duce. 

3. Many cathartics, such as the saHnes, draw fluid into the 
intestines from the blood and tissues; thereby filhng up 
the intestines with fluid, which is expelled by the resulting 
contractions of the intestinal muscles. At the same time, 
fluid is thus removed from the blood and tissues so that 
oedema (fluid in the tissues) may be lessened and the blood 
pressure reduced. 

Administration 

Cathartics which produce mild effects, or which produce 
their effects slowly, should be given at night. Those which 
produce rapid effects, should be given in the morning. 

Cathartics should never be given after meals as they may 
cause vomiting. 

Cathartics which cause violent action should not be given 
in cases where the intestine is diseased. 

For example — In tjrphoid fever or acute appendicitis violent 
cathartics should be avoided. In typhoid fever an active 
cathartic may increase the inflammation in the ulcers which 
are present in the intestinal mucous membrane in this disease. 
The violent contractions which result from such a cathartic 
may increase the tendency to haemorrhage and perforation. 

In cases of acute appendicitis the appendix may be very 
friable, and the violent contractions which result from many 
cathartics may cause a rupture of the appendix. 

In cases that have had an abdominal operation performed 
upon them, the nurse should never administer a cathartic with- 
out the doctor's order. 

When the operation has been performed upon the stomach 
or intestines, the greatest care must be exercised in giving 
cathartics, for example — in operations for the removal of 
the vermiform appendix, the removal of a part of the stomach 
and intestines or the suturing (sewing) of any of these organs. 
In such cases no cathartic should be administered before the 
third day after the operation, because the violent intestinal 
contractions may tear the delicate stitches in the wall of the 
intestines, and cause perforations with resulting peritonitis, 
that may be fatal. 



CATHARTICS 149 

Classification 

Cathartics may be divided into the following three classes, 
depending upon whether they cause mild action, moderate 
action, and more violent action : 

1. Laxatives 

2c Purgatives (Simple and Saline) 

3. Drastic Purgatives 

This distinction is not very well defined; since some 
cathartics produce mild effects in small doses, and greater, 
even violent effects in larger doses; but the classification here 
given is according to the effects produced by the doses us- 
ually administered, and is the most practical one. 

Cathartics may also be classified according to the part of 
the intestine they affect; the entire intestine, the duodenum, 
the small intestine or the large intestine. Another classifica- 
tion consists in grouping them according to their active 
principles. 

LAXATIVES 

Laxatives or aperients are medicines which cause a few 
movements of the bowels. The stools are formed, normal 
in character, and the movements are not accompanied by 
griping. 

Acting on the Entire Intestine 

Many foods which leave a great deal of residue or un- 
digested material, act as laxatives. Such foods as oatmeal, 
wheat, bran and many fruits are distinctly laxative. These 
may be given at night slightly flavored with sugar. Large 
quantities of water is also a good laxative. The following are 
the substances commonly used as laxatives: 

MOLASSES (Syrupus Fuscus) 

MILK SUGAR (Saccharum Lactis) 

GLYCERIN (Glycerinum) 

Glycerin is a very good laxative; given in doses of one to 
two ounces. 



150 MATERIA MEDICA 

MANNA: Manna is a drug obtained from the sap of the 
European ash tree which grows chiefly in Sicily and Cala- 
bria. It is given in doses of 15.0-60.0 gms. (Si-Bii.) 

Manna is used as a mild laxative, very often combined 
with other purgatives. 

TAMARIND: Tamarindus or tamarind is the preserved 
fruit of the Tamarindus indica, a tree growing in the East or 
West Indies. It is eaten like preserves, and is a very good 
laxative. 

CASSIA FISTULA: Cassia fistula, or purging cassia, is 
the fruit of the cassia fistula tree of East India and Egypt. 
It is used as a laxative in doses of 4.0-30.0 gms. (5i-§i.) 

SULPHUR (Brimstone). This is an inorganic element 
found in volcanoes. Many of its preparations are used as 
laxatives. 

Washed Sulphur 1.0-4.0 gms. grs. xv-5i 

(Sulphur Lotum) 

Precipitated Sulphur 4.0-15.0 gms. 5i-iv 

(Sulphur Praecipitatum) 

Sublimed Sulphur, or Flowers of Sulphur 

(Sulphur Sublimatum) 4.0-15.0 gms. 5i-iv 

Sulphur is best given in a small quantity of syrup. 

AGAR AGAR 

Agar agar is a substance made from various seaweeds 
of the East Indies. 

It is used as a purgative. It withdraws fluid from the 
stomach and intestines, forming a large jelly-like mass, 
which is indigestible, and increases the size of the fecal 
masses, so that the intestines become distended. 

The distention of the intestines produces frequent strong 
contractions of its muscle wall (peristalsis), which result in 
frequent movements of the bowels. 

Agar agar is given in milk, and is eaten like oatmeal gruel 
or any other cereal. 



CATHARTICS 151 

Preparations 
A-gar Agar 4.0-15.0 gms. ^i-§J 

Regulin is a preparation of agar agar with cascara, and 
is given in the same doses. 

Agar Agar with Calumba 

Agar Agar with Gentian 

Agar Agar with Phenolphthalein 

(Einhorn) 

LIQUID PETROLATUM, MINERAL OIL 

Liquid Petrolatum, Mineral Oil or Liquid Paraffin is a 
heavy oily substance which is obtained from petroleum oil. 
Chemically it belongs to the group of hydrocarbons. It is on 
the market under various names: Liquid Vaseline; Liquid 
Albolene, etc. Russian mineral oil is the same substance ob- 
tained from Russia, but is much heavier than the American 
product. 

ACTION 

Applied locally mineral oil is bland and soothing to the 
skin and mucous membranes. 

When taken internally it is not absorbed. When it enters 
the intestines it becomes mixed with the intestinal contents 
which it protects from the action of the digestive juices. 
The water of the intestinal contents is therefore not absorbed 
and the mass of foeces gradually becomes increased. This 
distends the intestines and bowel movements result. At the 
same time it lubricates the mucous membrane of the in- 
testines. 

Mineral oil is used as a laxative especially in chronic con- 
stipation; which is frequently due to a weakened condition of 
the intestinal muscles or to delicate kinks or adhesions of 
the intestines. 

It is given in doses of 15.0-30.0 gms. (§ss-i), two or three 
times a day. 

It occasionally causes nausea and it frequently has a 
tendency to ooze from the rectum between stools. 



152 MATERIA MEDICA 

Administration 

Liquid Petrolatum or mineral oil should be given about 
two or three hours after meals, undiluted. As it has a bland 
taste, which patients usually do not like, it should be flavored 
with some aromatic substance such as peppermint or cin- 
namon water. 

Acting on the Duodenum 

FEL BOVIS (Ox gall): Fel bovis is dried bile, obtained 
from the ox. It is used as a mild laxative and to increase 
the flow of bile. 

Preparations 

Purified Ox gall 0.3-1.2 gm. grs. v~xx 

(Fel Bovis Purificatum) 

LEPTANDRA: Leptandra is obtained from the roots and 
underground roots of the Veronica Virginia, an American 
plant. 

It is used as a mild laxative. The stools often contain 
a great deal of bile. 

Preparations 

Extract of Leptandra 0.1-0.25 gm. grs. ii-iv 

(Extractum Leptandrae) 

Acting on the Small Intestine 
OLIVE OIL (Oleum Olivae) 

Ohve oil acts as a very good laxative in wineglassful doses. 
It is said to increase the flow of bile. 

EUONYMUS : Euonymus or Wahoo, is the bark of the Eu- 
onymus atropurpureus, the spindle tree, growing in America. 
It is used as a mild laxative. 

Preparations 

Extract of Euonymus 0.06-0.2 gm. grs. i-iii 

(Extractum Euonymi) 



CATHARTICS 153 

Acting on the Large Intestine 

CASCARA: Cascara sagrada is obtained from the bark of 
the California buckthorn. Its official name is Rhamnus pur- 
shianae. It acts on the large intestine and is one of the best 
laxatives. It is usually given at night, and produces a nor- 
mal stool the next morning without griping. It is often 
given for habitual constipation. 

Preparations 

Extract of Cascara Sagrada 0.25 gm. grs. iv 

(Extractum Rhamni Purshianae) 

Fluidextract of Cascara Sagrada 1.0 c.c. m. xv 

(Fluidextractum Rhamni Purshianae) 

FRANGULA: Frangula is obtained from the bark of the 
European buckthorn or Rhamnus frangula. 

Preparations 

Fluidextract of Frangula 1.0-2.0 c.c. m. xv-xxx 

(Fluidextractum Frangulae) 

PURGATIVES 

Purgatives are drugs which produce frequent movements 
of the bowels, with soft stools accompanied by griping. 
There are two kinds of purgatives : Simple and Saline. 

1. Simple purgatives are plant or other substances which 
cause frequent movements of the bowels. 

2. Saline purgatives are inorganic (mineral) salts used as 
purgatives. These are often called hydragogue cathartics 
because they produce very frequent watery stools. 

Many purgatives are also called cholagogue cathartics 
because the stools resulting from their use are highly colored 
with bile. This is due to the fact that they act mainly on 
the duodenum or first part of the small intestine, and there- 
fore a^.so bring about contractions of the bile ducts, which 
pour more bile into the intestine. They do not increase the 
secretion of bile. 



154 MATERIA MEDICA 

SIMPLE PURGATIVES 

Large doses of the laxatives act as purgatives. 

Acting on the Duodenum 

CALOMEL: HYDRARGYRI CHLORIDUM MITE 

Calomel is a compound of mercury; the mild mercurous 
chloride. 

ACTION 

Calomel is used principally as a purgative. It produces 
frequent soft stools, very highly colored with bile, and it 
is often called, therefore, a cholagogue cathartic. 

It acts principally on the duodenum, the first part of the 
small intestine. It causes redness and increased secretion 
of the lining membrane of the intestine (irritation), which 
brings about contractions of its muscle wall (peristalsis). 
It thus also induces contractions of the bile ducts, which 
are closely attached to the duodenum or first part of the 
small intestine. The flow of bile into the intestine is then 
increased and the stools contain a great deal of bile. Calomel 
also acts as an antiseptic in the intestines, checking the 
growth of bacteria, It has a decided tendency to produce 
griping. 

It is also used to increase the flow of urine (diuretic 
action). 

Preparations 

Calomel 0.008-0.3 gm. gr. i~v 

(Hydrargyri Chloridum Mite) 

Administration 

Calomel may be given in small doses, frequently repeated. 
For example, gr. i every fifteen minutes until two grains 
are taken, or the two grains may be given in one single 
dose. It is often given with sodium bicarbonate: about 
grs. V of sodium bicarbonate with every gr. J of calomel to 
lessen the griping. 



CATHARTICS 155 

Calomel should be given between meals or at night. 
It should always be followed by a dose of one of the sa- 
line cathartics, so that the calomel will not remain in the 
intestines. Otherwise it may be changed to corrosive sub- 
Hmate in the intestines and cause the following poisonous 
symptoms: a metallic taste in the mouth, abdominal pain, 
nausea, vomiting, diarrhoea with bloody stools, and collapse 
(rapid, weak, thready pulse, slow, shallow respiration, cold, 
moist skin, dilated pupils). 

Milk, eggs and other albuminous food should not be given 
shortly after calomel. 

BLUE MASS— MASSA HYDRARGYRI 

This is a compound of mercury and is a milder purgative 
than calomel. It is always given in pill form, each pill 
containing about grs. iii-v of blue mass. 

Blue Mass 0.06-0.3 g.m grs. i-v 

(Massa Hydrargyri) 

MERCURY WITH CHALK, GRAY POWDER, HYDRARGY- 
RUM CUM CRETA 

This preparation is made of metallic mercury, with chalk 
and honey. It is always prescribed in powder form. It is 
milder than calomel. The chalk lessens the griping. 

PODOPHYLLUM 

Podophyllum is the underground root and rootlets of 
the Podophyllum peltatum, the May apple or mandrake, a 
perennial plant growing in Northern and Middle United 
States. Its active principle is a resin, podophyllin. It also 
contains an alkaloid, berberine. 

ACTION 

Podophyllum causes frequent copious bile stained stools 
about eight to twelve hours after it is given. This is the re- 
sult of its action on the duodenum. Since the bile ducts are 
attached to this part of the intestine, the flow of bile is also 



156 MATERIA MEDICA 

increased, and the stools are therefore stained with bile; 
podophyllum is often called vegetable calomel because it 
causes similar stools. 

It also causes bowel movements when given hypoder- 
mically as it is eliminated by the mucous membranes of the 
intestine. 

In poisonous doses the frequent stools may cause great 
exhaustion and collapse. 

Preparations 

Resin of Podophyllum 0.015-0.06 gm. gr. J-i 

(Resina Podophylli) 

PiUs of Podophyllum Belladonna and Capsicum 1 pill 

(Pilulae Podophylli Belladonnae et Capsici) 

Podophyllin 0.005-0.01 gm. gr. yVi 

(Unofficial) 

Acting on the Small Intestine 

CASTOR OIL— OLEUM RICINI 

Castor oil is a fixed oil (an oil which does not evaporate), 
obtained from the seeds of the Ricinus communis, a tree 
gro\\dng in aU warm countries. The seeds are wamied, and 
the oil is then pressed out of them. The oil ordinarily used, 
is obtained from Calcutta in India. 

Castor oil has no odor, but a very unpleasant nauseating 
taste. 

The active principle of castor oil is ricinoleic acid, and its 
compounds ricinoleates. Old castor oil contains more rici- 
noleic acid, and is therefore often more efficacious. 

ACTION 

Local Action: On the skin and mucous membranes, castor 
oil is very soothing. 

Internal Action 

In the mouth: It has an unpleasant nauseating taste. 
Even its smell will sometimes produce nausea. 



CATHARTICS 157 

In the intestines : Castor oil produces frequent movements 
of the bowels in about three to six hours, not accom- 
panied by griping. The stools are soft, but after the move- 
ments have occurred, the bowels are apt to be constipated. 

Castor oil is decomposed by the digestive juices, forming 
ricinoleic acid. This forms compounds with the alkaline 
salts in the intestines (ricinoleates) . These substances slightly 
increase the intestinal secretions, and affect the nerve endings 
of the intestinal wall. Impulses are thus sent to the spinal 
cord, to bring about contractions of the muscle wall of the in- 
testines, thereby causing frequent movements of the bowels. 
(An action brought about in this way is called a reflex action) . 

The ricinoleates which are formed in the intestine, are 
absorbed into the blood, and are then excreted by all the 
secretions. Because it is eliminated in the milk, castor oil 
often acts as a laxative on nursing infants. 

Castor oil is one of the best cathartics for temporary 
use; because of its soothing after effect which produces con- 
stipation. 





Preparations 






Castor Oil 
(Oleum Ricini) 

For an infant 


15.0- 
4.0- 


-30.0 c.c. 
- 8.0 c.c. 


3i- 


-i 
ii 



Laxol: This is a tasteless preparation of castor oil (not 
official). 

Castor oil is also put up in flexible capsules, to disguise 
its unpleasant taste. 

(The castor oil bean is never used because it contains a 
very poisonous substance, ricin.) 

Administration 

In giving castor oil the unpleasant taste must be dis- 
guised. To some people, however, the taste is not at all 
unpleasant. For example: the Chinese are very fond of 
castor oil and do not mind its taste, in fact, they use it as 
a food. 

Castor oil should always be given cold, as the taste is then 



158 MATERIA MEDICA 

not as readily appreciated. The object of disguising the taste 
is to coat the oil with a substance which will make the oil 
taste more pleasant. This may be done in the following ways : 

1. By giving the oil in an equal part of glycerin or brandy. 

2. By making an emulsion of thv. oil by pouring it into 
flavored soda water, sarsaparilla or grape juice. 

3. The patient's mouth may be rinsed out with a little 
whiskey or peppermint, before giving the castor oil. 

4. It may be poured between two layers of lemon juice, 
grape juice, orange juice, or whiskey, as in the following 
method : 

Castor Oil Cocktail 

Rinse out the medicine glass wdth some whiskey or lemon 
juice, and pour about a teaspoonful of lemon juice in the 
bottom of the glass. The castor oil is then added; and 
on top of that, a teaspoonful of whiskey, raspberry juice 
or peppermint. The mixtm^e is then administered. 

A little vichy or seltzer, or an olive, will often remove 
the unpleasant nauseous feeling which follows the taking of 
a dose of castor oil, even when its taste is disguised. 

Acting on the Large Intestine 

RHUBARB 

Rhubarb is obtained from the root of the Rheum officinale, 
a plant growing in China and Tartary. The plant is similar 
to the ordinary rhubarb, but is much larger. 

ACTION 

Rhubarb acts principally upon the large intestine as a 
purgative, producing frequent fluid stools, not accompanied 
by griping. These stools are colored with bile. On account 
of the tannic acid which it contains, rhubarb constipates 
after its purgative action. 

The urine, and in nursing women, the milk, is colored 
yellow when rhubarb is taken. 

Rhubarb is particularly valuable in cases where soHd 
masses in the stools produce pain. For example, in haemor= 



CATHARTICS 159 

rhoids, by softening the stools, the pain produced by the 
passage of hard fecal masses, is often relieved. 

Preparations 

Extract of Rhubarb 0.3-0.6 gm. grs. v-x 

(Extractum Rhei) 

Compound Rhubarb Pill 1-5 pills 

(Pilula Rhei Composita) 

(This contains aloes, myrrh, oil of peppermint and rhubarb) 

Compound Rhubarb Powder 1.0-4.0 gms. grs. xv-3i 

(Pulvis Rhei Compositus) 

(Gregory's powder) 

(This contains magnesia, ginger and rhubarb) 

Aromatic Syrup of Rhubarb 2.0-8.0 c.c. 5ss-ii for a 

(Syrupus Rhei Aromaticus) child. 

Rhubarb and Soda Mixture 8.0 c.c. 3ii 

(Mistura Rhei et Sodae) 

This also contains ipecac and is used more for stomach 
conditions than as a cathartic. 

ALOES 

Aloes is the dried juice of several species of Aloes, a plant 
growing in the Barbadoes, and other islands in the Indian 
Ocean and in Arabia. It is one of the oldest drugs in medi- 
cine. It was used in the time of Alexander the Great, about 
300 B. C. 

The preparations are made up from the Barbadoes and 
Socotrine Aloes, obtained from the Barbadoes, and the Island 
of Socotra. The active principle is aloin, which belongs to a 
number of substances known as the anthracene group be- 
cause they are all similar to anthracene, a substance ob- 
tained from coal tar. 

ACTION 

Aloes acts principally on the large intestine, causing 
irritation, with dilatation of the blood vessels. This action 



160 MATEKlA MEDIOA 

results in peristalsis, causing frequent movements of the 
bowels. 

Administration 

Aloes is seldom administered alone. It is usually given 
together with other purgatives. 

Preparations 

Solid Preparations 

Pill of Aloes 1-5 pills 

(Pilulae Aloes) 

Each pill contains 0.12 gm. (grs. ii) of aloes 

Pills of Aloes and Iron 1-5 pills 

(Pilulae Aloes et Ferri) 
Each pill contains 0.12 gm. grs. ii of aloes 

Pills of Aloes and Mastiches 1-5 pills 

(Pilulae Aloes et Mastiches) 

(Lady Webster's dinner pill.) Each pill contains grs. li of aloes 

Pills of Aloes and Myrrh 1-5 pills 

(Pilulae Aloes et Myrrhae) 

(Rufus' pill.) Each pill contains 0.12 gm. grs. ii of aloes 



Aloin (active principle) 


0.015 gm. 


gr.i 


(Aloinum) 






Lapactic Pills or A. B. & S. piUs 


dose 2 pills 




(Pilulae Laxativae Compositae) 






Each pill contains, 






Aloin 


gr.i 




Extract of Belladonna 


gr.i 




Strychnine 


gr-iTo 




Powdered Ipecac 


gr. iV 




Fluid Preparations 




Tincture of Aloes 


2.0-8.0 c.c. 


5ss-ii 



(Tinctura Aloes) 

Aloes is also contained in the compound rhubarb pill, com- 
pound extract of colocynth, and compound tincture of benzoin. 



CATHARTICS 161 

SENNA 

Senna is obtained from small dried leaves of an oriental 
shrub. 

There are two kinds of senna plants: Cassia acutifolia, 
which comes from Alexandria in Egypt, and Cassia angus- 
tifolia, from India. The active principle of senna belongs to 
the same group of substances (anthracene derivatives) as 
aloin. 

ACTION 

Senna acts principally on the large intestine, producing 
in five hours after it is given, frequent watery stools, usually 
accompanied by severe griping pains. 

To overcome the griping, it is usually combined with other 
substances, especially carminatives. 

It is excreted in the urine. In nursing women it is excreted 
in the milk, and it will then act as a laxative on the nursing 
infant. 

Senna in small doses is often given to children as a laxative. 

Preparations 

Confection of Senna 4.0-8.0 c.c. 5i-ii 

(Confectio Sennae) 

Containing senna, cassia fistula, tamarind, prune, fig, 
sugar and oil of coriander. 

Compound Infusion of Senna (Black Draught) 

(Infusum Sennae Compositum) 30.0-120.0 c.c. §i-iv 

Contains senna, manna, magnesium sulphate and fenneL 

Syrup of Senna 4.0-16.0 c.c. oi-iv 

(Syrupus Sennae) 

Senna tea is a preparation often given to children. It is 
an infusion of senna leaves, made from a teaspoonful of 
leaves to a cup of water. 



162 MATERIA MEDICA 

PHENOLPHTHALEIN 

Phenolphthalein is a chemical substance made from car- 
bolic acid; phthalic anhydride and sulphuric acid. 

It is used in the laboratory to test the reaction of various 
substances, since it turns red when an alkah is added to it. 

ACTION 

Phenolphthalein acts as a very good purgative, producing 
frequent soft stools mth little griping. It acts on the large 
intestine, increasing peristalsis and preventmg absorption of 
fluids, thus causing bowel movements. 

Preparations 
Phenolphthalein 0.1-0.2 gm. grs. ii-iii 

Acting on the Entire Intestine 
GLYCYRRHIZA, LICORICE ROOT 

Licorice is the root of Glycyrrhiza glabra, an English plant. 
Its active principle is a glucoside, glycyrrhizin. 

Apphed to the skin it is soothing and protectmg (demul- 
cent). Taken internally it is a mild purgative. 

Preparations 

Compound Licorice Powder 4.0 gms. 3 i 

(Pulvis Glycyrrhizae Compositus) 

This contains senna, Hcorice root, sulphur, fennel and 
sugar. It should be given in very httle water, as it may 
cause nausea, but it should always be followed by a drink 
of water. 

Licorice powder is best given at bedtime. It is an excellent 
purgative, producing frequent fluid stools without griping, 
in about ten to fifteen hours; or in three to six hours, when 
given on an empty stomach. 

It is especially valuable in patients suffering from haemor- 
rhoids. The fluid stools resulting from licorice powder 
lessen the pain produced by movements of the bowels in 
cases of haemorrhoids. 



CATHARTICS 163 

HORMONAL 

(not official) 

Hormonal is a fluid substance prepared from the spleen of 
a rabbit about an hour after being fed a heavy meal. 

It causes movements of the bowels when injected intra- 
venously or intramuscularly. It is used as a cathartic when 
the bowels are distended after an operation, or in cases of 
chronic constipation. It is given in doses of 15-40 c.c. The 
injections are frequently followed by collapse. 

ESERINE OR PHYSOSTIGMINE 

Eserine or Physostigmine is frequently given hypoder- 
mically to move the bowels and reheve distention, especially 
after operations. It acts by increasing the peristalsis of the 
intestinal muscle. It may cause collapse. 

SALINE PURGATIVES 

Saline purgatives are inorganic (mineral) salts used as 
purgatives. They are all combinations of alkalies with 
acids. Only those salts are used which are not readily ab- 
sorbed. The saline purgatives all act on the entire intestine. 

Action 

Locally: The saline purgatives produce no effect. 

In the mouth : Most of the saline purgatives have a harsh 
unpleasant bitter taste. 

In the stomach : They often produce nausea and vomiting. 

In the intestines: They produce frequent fluid stools 
accompanied by griping. 

Mode of Action 

When given in small doses, or in dilute solutions, so that the 
percentage of salt in the intestine is less than that in the 
blood (anisotonic), or equal to that in the blood (isotonic), 
the salts are not absorbed, but they prevent the passage of 
fluids through the lining membrane of the stomach and intes- 
tines (absorption). This fluid then distends the intestines, 



164 MATERIA MEDICA 

especially the large intestine, causing contractions of their 
muscle wall with resulting fluid stools. 

When given in larger doses, or in concentrated solutions, so 
as to make the percentage of salt in the intestines greater 
than that in the blood (hypertonic), the salts are not ab- 
sorbed. They merely withdraw fluid into the intestines 
from the blood and tissues by the process of osmosis until the 
salt in the intestines becomes diluted sufficiently; that is, 
until it contains the same percentage of salt as the blood 
(isotonic). By this time the quantity of fluid in the intes- 
tines has increased to such an extent that the intestines, 
especially the large intestine, become distended and frequent 
watery stools result. 

Since the withdrawal of fluid from the tissues takes con- 
siderable time, bowel movements from concentrated salt 
solutions may occur only after ten or twenty hours. On the 
other hand, dilute solutions, because they are not absorbed, 
but merely distend the intestines, usually induce much more 
rapid effects. 

The saline cathartics are particularly valuable in cases 
where there is a great deal of fluid in the tissues (oedema), 
for example, to reduce oedema of the legs in nephritis, 
.or to reduce ascites (fluid in the abdomen). In such cases 
they withdraw the fluid from the tissues into the intes- 
tines, and the frequent movements of the bowels which 
result, eliminates this excessive fluid, relieving the oedema 
or the ascites. 

Saline cathartics are also given to reduce blood pressure, be- 
cause they withdraw fluid from the blood. By lessening the 
total quantity of blood in the bod}^, blood pressure is reduced. 

The saline cathartics should not be given in cases where 
there are ulcers or inflammation in the intestines, as they 
may aggravate this condition. 

A small portion of each dose of some of the sahnes is ab- 
sorbed, and acts on the kidneys as a diuretic, increasing the 
flow of urine. 

Administration 
The saline cathartics are best given well diluted, pref- 



CATHARTICS 185 

erably in the morning, when the stomach is empty. They 
move the bowels in a few hours. 

To reheve oedema they should be given in a concentrated 
solution, since more fluid is thus removed, and the effect is 
more prolonged. 

The preparations of the saline purgatives are best given 
in cold seltzer or vichy. If they are given hot, the addition 
of 10 or 15 drops of tincture of ginger makes them taste 
more agreeable. They should not be given stronger than 
5-10% solutions. 

Preparations 

Salts of Sodium 

Sodium Sulphate (Glauber's Salt) 2.0-30. gms. Sj-gi 
(Sodii Sulphas) 

This is soluble in 3 parts of water. This is best given in 
solution, in vichy or seltzer, not stronger than 5-10% 
solutions. 

Sodium Phosphate 1.0-30.0 gms. grs. xv-§i 

(Sodii Phosphas) 

This is soluble in 6 parts of water. 

It is best given in milk, not stronger than 5-10% solutions. 

Salts of Potassium 

Potassium Sulphate 1.0-4.0 gms. grs. xv-3i 

(Potassii Sulphas) 

Potassium Bitartarate (Cream of tartar) 

(Potassii Bitartaras) 1.0-4.0 gms. grs. xv-3i 

Potassium and Sodium Tartarate (Rochelle Salt) 
(Potassii et Sodii Tartaras) 8.0-16.0 gms. 3ii-iv 

This is soluble in IJ parts of water. It tastes pleasantev 
than Epsom salts. 

Salts of Magnesium 

Magnesia Oxide, Calcined Magnesia, or Light Magnesia 
(Magnesii Oxidum) 2.0-4.0 gms. grs. xxx-5i 



166 MATERIA MEDICA 

Magnesia is very mild in action. 

Magnesium Sulphate (Epsom salt) 

(Magnesii Sulphas) 2.0-30.0 gms. 5i-§i 

This is soluble in ij parts of water. 

Magnesium sulphate is very commonly used. It has a 
very unpleasant taste and is best given in seltzer or vichy. 

Large doses produce very frequent stools, with a good deal 
of griping. 

The preparations of magnesia are best given in powder 
form, sweetened to disguise the taste. 

Carlsbad Salt 
(Sal Carolinum) 

This is a mixture of the mineral salts obtained by evap- 
orating the water of the carlsbad mineral spring in Bohemia. 

Artificial Carlsbad Salt 
(Sal Carolinum Factitium) 

This is a mixture of the salts contained in natural carls- 
bad salts, and consists of the following salts : 

Dried Sodium Sulphate 44 parts 

Potassium Sulphate 2 

Sodium Chloride 18 " 

Sodium Bicarbonate 36 

Artificial carlsbad water contains about 70 parts of this 
salt to 1000 c. c. of water. 

EFFERVESCENT PREPARATIONS 

These preparations of the salts form gas (effervesce), 
when dissolved in water. 

Seidlitz Powder 

(Pulvis Effervescens Compositus) 

This is made up in two powders: 

1. The powder wrapped up in blue paper contains: 

Sodium Bicarbonate 2.5 gms. grs. xl 

Rochelle Salts 

(Potassium and Sodium Tartarate) 8.0 gms. 5ii 



CATHARTICS 167 

2. The powder wrapped up in white paper contains: 

Tartaric Acid 1.5 gms. grs. xxv 

A seidlitz powder should always be administered at the 
bedside. Each powder should be dissolved in half a glass of 
water, the two solutions mixed and the mixture given to 
the patient. 

The combination of the tartaric acid and sodium bicar- 
bonate forms carbon dioxide gas, which causes the effer- 
vescence. Seidlitz powder is often given to distend the 
stomach, for diagnostic purposes. 

Solution of Citrate of Magnesia 

(Liquor Magnesii Citratis) dose 150.0-360.0 c.c. Bv-xii 

This is a solution of magnesium citrate and citric acid, 
to which potassium bicarbonate is added. It is usually 
kept in tightly closed bottles, and effervesces when it is 
poured in a glass. 

Effervescent Magnesium Sulphate 15.0-30.0 gms. Bi-i 
(Magnesii Sulphas Effervescens) 

This contains epsom salt, sodium bicarbonate, tartaric 
and citric acids. The mixture effervesces when mixed with 
water. 

Effervescent Sodium Phosphate 8.0-15.0 gms. Sii-Si 

(Sodii Phosphas Effervescens) 

This contains sodium phosphate, sodium bicarbonate, 
tartaric and citric acids. The mixture effervesces w^hen 
dissolved in water. 

Effervescent Lithium Citrate 4.0-8.0 gms. 5i-ii 

(Lithii Citras Effervescens) 

This contains lithium citrate or lithium carbonate, sodium 
bicarbonate and citric acid. 

All the effervescent preparations, if not already in solu- 
tion, should be given in a tumblerful of water. 

Many natural mineral waters are used as cathartics. 
The fcllowing are the preparations commonly used: 



168 MATERIA MEDICA 

Hunyadi Water (not official) 

Carlsbad Water 

This contains magnesium and sodium sulphate^ and other 
salts. 

Apenta Water (not official) 

This consists mainly of sodium and magnesium sulphate 
with small quantities of sodium chloride and Sodium bi- 
carbonate. 

Pluto Water (not official) 

This is obtained from the French Lick springs in Indiana, 
and consists mainly of sodium and magnesium sulphates 
with small quantities of sodium chloride, calcium, magne- 
sium and iron salts. 

DRASTIC CATHARTICS 

Drastic cathartics are drugs which cause frequent fluid 
movements of the bowels, accompanied by severe griping 
pains. 

ACTION 

The drugs used as drastic cathartics act principally on 
the small intestine. They increase the secretions of the 
intestinal mucous membrane and the contractions of the 
intestinal muscles, thus causing frequent copious fluid stools 
accompanied by griping. The drastic cathartics withdraw 
fluid from the tissues into the intestines, and thus tend to 
relieve oedema and ascites. The copious fluid stools fre- 
quently cause severe collapse. Drastic cathartics should 
therefore not be given to very young or to very old patients. 
In pregnant women they may induce abortion. When sev- 
eral drastic cathartics are given together they are not so apt 
to cause such violent action as when given alone. 

Poisonous Effects 

In large doses, most of the drastic cathartics are violent 
poisons. 



CATHARTICS 169 

The symptoms which such doses cause are nausea, vom- 
iting, abdominal pain and profuse diarrhoea. The stools 
contain blood and flakes of the lining membrane of the 
intestines, which is usually very severely inflamed by large 
doses. In spots, the lining membrane of the intestine may 
even be destroyed by such doses. 

As a result of these symptoms, there is usually severe 
collapse: the skin is pale, moist and cold, the breathing is 
slow and shallow, the pulse is rapid, thready and weak, the 
pupils are widely dilated, and the patient finally goes into 
coma and may die. 

CROTON OIL (OLEUM TIGLII) 

Croton oil is a fixed oil (an oil which does not evaporate), 
pressed out from the seeds of the Croton tiglium, a shrub 
growing in Hindostan and other parts of Southern Asiao 
Its active principle is: an acid, crotonoleic acid. 

ACTION 

Croton oil acts principally on the small intestine; pro- 
ducing in one or two hours after it is given, frequent large 
fluid stools with severe griping pains. The violent move- 
ments of the bowels continue for about twelve to fifteen 
hours, and each stool is accompanied by severe griping, so 
that the patient soon becomes exhausted. 

Mode of Action 

Croton oil acts like castor oil. Crotonoleic acid is formed 
by the digestive juices, and causes the bowel movements. 
Some of the crotonoleic acid is absorbed into the blood, 
and is excreted by all the secretions. 

Preparations 

Croton Oil 0.06-0.12 c.c. m. i-ii 

(Oleum Tiglii) 

Administration 

Croton oil is given principally in cases where the patient 
is unable, or unwilling to swallow. In cases of apoplexy for 



170 MATERIA MEDICA 

instancej when the patient is unconscious ; or in an attack of 
mania, when the patient is so excited, that he is unwilhng to 
swallow medicine. 

In such cases, one or two drops, either of the pure croton 
oil, or the oil dissolved in glycerin or olive oil, are placed on 
the back of the tongue w^ith a spoon. The oil may also be 
given on a piece of sugar, or on a few bread crumbs. 

Croton oil is occasionally applied to the skin, to produce 
redness, and thereby to relieve congestion of deeper organs, 
(counterirritant action). A few drops of croton oil are 
poured on a piece of flannel, and rubbed on the skin. It 
may also be added to ohve oil, or to a liniment, and ap- 
plied by rubbing on the skin. 

JALAP— JALAPA 

Jalap is the root of the Ipomoea jalapa, a twining vine 
of Mexico. Its active principle is a resinous substance, 
jalapin. 

It is one of the most commonly used drastic cathartics^ 

Preparations 

Resin of Jalap 0.1-0.3 gm. grs. ii-v 

(Resina Jalapae) 

Compound Jalap Powder 1.0-4.0 gms. grs. xv-5i 

(Pulvis Jalapae Compositus) 

This contains jalap and cream of tartar. 

ELATERINE 

Elaterium is the juice obtained from the fruit of Ecballium 
elaterium, or squirting cucumber, of Greece and Western 
Asia. This fruit contains an inner sac which is filled with 
juice and contains the seeds. The dried juice is elaterium, 
from which is obtained elaterine, the active principle, which 
is the resinous substance used. 

Locally: Elaterine is very injurious to the skin. It fre- 
quently causes inflammation and ulcers, on the fingers of 
those who constantly handle the drug. 



CATHARTICS 171 

Internally : It is the best drug to produce fluid stools and is 
therefore used to remove fluid from the tissues in the cases of 
oedema and ascites. It is also used to reduce blood pressure 
in cases of apoplexy. 

Elaterine is frequently given hypodermically. 



Elaterine 
(Elaterinum) 

Triturate of Elaterine 
(Trituratio Elaterini) 

Containing 1 part of elaterine, to 9 parts of sugar of milk. 
The following drastic cathartics are seldom given alone. 
They are usually combined with other cathartics. 

COLOCYNTH (COLOCYNTHIS) 

Colocynth is the pulp of the bitter cucumber or CitruUus 
colocynthis, which grows on vines in Egypt, Syria, South 
Africa, Turkey and Japan. Its active principle is colocynthin, 
a resinous substance. 



Preparations 




0.001-0.005 gm. 


a-r ^ - 1 

g^- "6 TS 


0.015-0.06 gm. 


gr. i-i 



Preparations 

Extract of Colocynth 0.015-0.03 gm. gr 

(Extractum Colocynthidis) 



2 



Compound Extract of Colocynth 0.2-1.0 gm. grs. iii-xv 

(Extractum Colocynthidis Compositum) 
Containing colocynth, aloes, seammony and cardamom. 

Colocynthin (acMve principle) 0.005-0.001 gm. grs. xV~i 

(Not official) 

GAMBOGE (GAMBOGIA) 

Gamboge is a gum resin obtained from the Garcinia 
hanburii, a tree of Siam. The leaves and young branches 
of the tree are broken off, and the juice, which is the gum 
resin, is caught from the broken twigs in vessels and dried. 



172 MATERIA MEDICA 

Gamboge is one of the most violent drastic purgatives and 
may cause very severe collapse. 

Preparations 

Gamboge 0.1-0.6 gm. gr. ii-x 

(Gambogia) 

SCAMMONY (SCAMMONIUM) 

Scammony is the dried milky juice (resin), obtained from 
the root of the Convolvulus scammonia, a vine growing in 
Syria. Its active principle is jalapin, a resinous substance. 

Scammony is used principally as a drastic cathartic. 

Preparations 

Resin of Scammony 0.2-0.5 gm. grs. iii-viii 

(Resina Scammoniae) 

COMPOUND PREPARATIONS OF DRASTIC PURGATIVES 

Compound Cathartic Pills 
(Pilulae Catharticae Compositae) 
This is very frequently used. Each pill consists of: 

Compound Extract of Colocynth 0.08 gm. gr. 1| 

Calomel 0.06 gm. gr. i 

Resin of Jalap 0.2 gm. gr. J 

Gamboge 0.015 gm. gr. J 

1 pill is given for a purgative, 3 pills for a drastic effect. 

Vegetable Cathartic Pills 
(Pilulae Cartharticae Vegetabiles) 



Compound Extract of Colocynth 


0.06 gm. 


gr. 


Extract of Hyoscyamus 


0.03 gm. 


gr. 


Resin of Jalap 


0.02 gm. 


gr. 


Extract of Leptandra 


0.015 gm. 


gr. 


Resin of Podophyllum 


0.015 gm. 


gr. 



and about m. i of oil of peppermint for every hundred pills. 
The peppermint and the hyoscyamtus lessen the griping. 



CATHARTICS 173 

ENEMATA 

Enemata are fluids which are injected into the rectum. 
They are of two kinds: cathartic and nutritive. 

Cathartic Enemata 

Cathartic enemata are given to move the bowels. They 
usually act by distending the large intestine, so that peris- 
talsis is set up. The contents of the intestines are expelled 
and frequent movements of the bowels result. 

The following are the substances commonly used in ene- 
mata: 

Plain Water 

Salt Solution 

Soap Suds 

and various Cathartics. 

An excellent combination of cathartics which is given as 
an enema consists of: 

Glycerine 120.0 gms. B iv 

Magnesium Sulphate 120.0 gms. § iv 

Ox gall 8.0 gms. 5 ii 

Turpentine 8.0 gms. 5 ii 

The turpentine is particularly valuable because it helps 
to expel gas. Another good combination consists of milk 
and molasses, which is especially efficient. The sugar and 
milk form gas which distends the intestine, causing frequent 
copious movements of the bowels. Starch is frequently added 
to lessen the irritation of the rectum. 

Nutritive Enemata 

Nutritive enemata are usually given to nourish the pa- 
tient, when food cannot be taken by the mouth. They 
usually consist of milk, eggs, various meat juices, broths, or 
special prepared substances. The substances should be 
completely peptonized. They should be given very slowly, 
best by the Rectoclysis or Murphy Method. 



174 



MATERIA MEDICA 



ABSORBENT 
CHARCOAL (CARBO LIGNI) 

Charcoal is made from wood or bones. It readily absorbs 
gases and is therefore used to remove gas from the intes- 
tines. 

It is best given in capsules, since it soon loses its efficiency 
when dissolved in a fluid. 



SUMMARY OF PRINCIPAL CATHARTICS 

Cathartics Arranged According to Site and Rapidity of Action 







Ra- 




Ra- 




Ra- 




Ra- 




Acting on 


pidity 


Acting on 


pidity 


Acting on 


pidity 


Acting on 


pidity 


Group 


Duode- 


of 


Small In- 


of 


Large In- 


of 


Entire 


of 




num 


Ac- 
tion 


testine 


Ac- 
tion 


testine 


Ac- 
tion 


Intestine 


Ac- 
tion 






Hrs. 




Hrs. 




Hrs. 




Hrs. 


Laxatives 






Olive Oil 


8-12 


Cascara 
Agar Agar 


8-12 
8-12 


Mineral Oil 


8-12 




Calomel 
Mercury 
prepara- 
tions 


2-8 

2-8 






Rhubarb 
Aloes 


8-12 

8-12 


Licorice 
Powder 

Physostig- 
mine 


8-12 


Purgatives 


Podophyl- 




Castor Oil 


2-8 


Senna 


8-12 


Saline Ca- 




lura 


8-12 






Phenolph- 




thartics 














thalein 


8-12 


(when di- 














A.B.andS. 




lute) 


1-2 












Pill (La- 




(when con- 














pacticpill) 


8-12 


centrated) 


6-12 








Jalap 

Elaterine 

Colocynth 


2-4 
2-4 










Drastic 






Gamboge 


2-4 






Croton Oil 


K-2 


Cathartics 






Scammony 
Compound 

Cathartic 

Pill 


2-4 
2-4 











Note: The cathartics that act slowly are best given at night. 



CATHARTICS 



17^ 



SUMMARY OF PRINCIPAL CATHARTICS (Continued) 
Time of Administration 



Group 


At night 


Before break- 
fast 


Between meals 


Special Meth- 
ods of Admin- 
istration 


Laxatives 


Cascara 
Sulphur 
Agar Agar 




Olive oil 


Mineral oil Liq- 
uid Petrolatum 
(2 hrs. after 
meals) 


Purgatives 


Podophyllum 
Penolph- 

thalein 
Compound 

Licorice 

Powder 


Saline 
Purgatives 


Calomel 
Mercury 

preparations 
Castor oil 
Rhubarb 
Aloes 
Senna 
A. B. and S. pill 

(Lapactic pill) 


Physostigmine 
(hypodermic- 
ally) 


Drastic Ca- 
thartics 






Croton oil 
Jalap 
Elaterine 
Colocynth 
Gamboge 
Scammony 
Compound Ca- 
thartic pill 


Elaterine (hypo- 
dermically) 



Types of Action 



Pharmacological Action 


Mechanical 
Action 


Salts, metals and 

other chemical 

substances 


Oils 


Anthracene 

substances 

(coal tar 

derivatives) 


Resins 




Calomel 

Mercury prepara- 
tions 

Phenolphthalein 

Saline Cathartics 
(Salt action) 


Olive oil 
Castor oil 
Croton oil 


Cascara 

Frangula 

Rhubarb 

Aloes 

Senna 


Podophyllin 

Jalap 

Elaterine 

Colocynth 

Gamboge 

Scammony 


Liquid Petrola- 
tum or min- 
eral oil 

Agar Agar 



CHAPTER X 

ANTHELMINTICS 

Anthelmintics are drugs which are principally used to 
destroy or expel intestinal worms. The drugs which destroy 
these worms are often called vermicides, and those which 
expel them, vermifuges. This difference in their action 
really depends, however, upon the amount of drug given, 
and how soon afterwards the bowels are moved. Thus, a 
large dose of one of the anthelmintics, if it remains in the 
intestine, will destroy, while a smaller dose will merely 
expel the worm. 

With the exception of pelletierine, which has a specific 
action on tape worms, most of the anthelmintics do not 
affect the worms selectively. 

All the anthehnintics are poisonous both to the worm and 
to the patient, but they are very slowly absorbed, so that 
their poisonous action is manifested mainly on the worm. 
Occasionally, if they are not followed by a cathartic, the 
drugs may be absorbed, and poisonous symptoms then re- 
sult. 

The anthelmintics are best classified according to the 
particular worm for which they are used. 

The following are the most common worms which often 
occur in the intestines: 

1. Tape Worms, or Taeniae. 

2. Round Worms, or Lumbrici. 

3. Thread Worms, Seat Worms or Ascarides. 

4. Hook Worms, or Uncinariae. 

The diagnosis of the form of worm is usually made by 
finding the characteristic eggs in the stools. 

Administration 

In giving any of the anthelmintics, it is important that 
the following routine measures be carefully carried out: 
1. The patient should be given a very fight diet, a day or 

176 



ANTHELMINTICS 177 

two before the drug is administered, or better still, no food 
should be given for twenty-four hours before. 

2. The bowels should be thoroughly moved with a hght 
laxative, the day before administration. 

3. The drug should best be given early in the morning 
on an empty stomach. 

4. About four to eight hours after the administration, a brisk 
cathartic such as calomel or castor oil, should be given, to ex- 
pel the worm. Occasionally a cathartic like calomel is given 
together with the drug. 

No food should be given until the bowels have moved. 

TAENICIDES 

Taenicides are drugs which destroy or remove tape worms. 

Tape worms are long flat worms which consist of many 
segments. They often inhabit the intestine as a result of 
eating meat or pork infected with their eggs. 

MALE FERN (ASPIDIUM FILIX MAS) 

Male fern or filix mas is obtained from the underground 
stems of the Dryopteris filix mas and of Dryopteris marginalis, 
European ferns. 

The active principles of these plants are a number of 
neutral and acid substances such as aspidin. Filicic acid was 
formerly supposed to be the active principle. 

ACTION 

When taken internally, male fern has a very uaipleasant, 
nauseous taste, and it destroys tape worms and hook worms. 

Poisonous Effects 

In some individuals, if large doses of the drug are given^ 
it may be absorbed and cause: 

1. Abdominal pain. 

2. Nausea, vomiting and diarrhoea. 

3. Muscular twitchings. 

4. Convulsions, collapse, coma, and death. 



178 MATERIA MEDICA 

Administration 

The oleoresin or liquid extract is usually given, either in 
pills, capsules or as a suspension in mucilage. 

Preparations 

Oleoresin of Aspidium 2.0-8.0 c.c. 3|-ii 

(Oleoresina Aspidii) 

New and Non-official Preparations 

Filicic Acid Amorphous 0.5-1.0 gm. grs. viii-xv 

(Acidum Filicicum Amorphum) 

Filmaron 10 c.c. 5iiJ 

This is a substance obtained from an ethereal extract of 
aspidium. It is said to be safer than aspidium. 
This is a 10% solution of filmaron in castor oil. 

cusso 

Cusso, kousso or brayera, are the female flowers of Hagenia 
abyssinica or Brayera anthelmintica, an Abyssinian tree. Its 
active principle is a neutral resin, kosotoxin, but it also con- 
tains tannic acid, a volatile oil and other substances. 

ACTION 

Cusso has a bitter taste and contracts mucous membranes. 
Its principal effect is to destroy tape worms. 

Large doses occasionally cause nausea, vomiting, diarrhoea 
and rarely, collapse with an irregular pulse. 

Preparations 

Cusso is usually given in doses of 15.0 gms. (51) of the 
Dowdered flowers in water as a suspension. 

Fluidextract of Cusso (not official) 4.0-16.0 c.c. 5i-iv 

(Fluidextractum Cusso) 

No cathartic is required after cusso, though the usual 
preparatory methods should be carried out. 



ANTHELMINTICS 179 

GRANATUM (POMEGRANATE) 

Granatum is the bark of the stem and root of Punica 
granatum or pomegranate. Its active principles are the 
alkaloids pelletierine or punicine, and isopunicine; and it 
also contains a large amount of tannic acid. 

ACTION 

Granatum and its alkaloids, have a specific destructive action 
on tape worms. It has a very unpleasant taste and is not a 
safe drug to use. 

Poisonous Effects 

Overdoses of pelletierine or granatum, paralyze the nerve 
endings of the muscles, causing effects like those of curara 
poisoning. i 

Symptoms ; 

1. Mental dullness and confusion of ideas. | 

2. Dizziness. 

3. Great weakness of the limbs, even paralyses. 

4. Dimness of vision. 

5. Occasionally nausea, abdominal pain, perhaps vomiting 
and tremors of the muscles of the legs. 

Administration 

Granatum is usually given as a decoction made from about 
30.0-60.0 gms. (5i-ii) of fresh bark, in about 250.0 c.c. (ipt.) 
of water. The drug is then given in two parts at intervals 
of an hour each, and the last dose should be followed in a 
half to two hours by a cathartic. 

Preparations 

Fluidextract of Pomegranate 2.0 c.c. m. xxx 

(Fluidextractum Granati) 

Pelletierine Tannate 0.25 gm. grs. iv 

(Pelletierinae Tannas) 

This is a mixture of all the alkaloids of pomegranate bark. 



180 MATERIA MEDIC A 

PEPO (PUMPKIN SEED) 

Pepo is the ripe seed of Cucurbita pepo or the ordinary 
pumpkin. Its active principle is a fixed oil and a resin. 

ACTION 

Pumpkin seeds are a very efficient and harmless remedy 
for tape worms. 

Administration 

The patient should fast the day before the drug is to be 
given, and the following morning, about two to four ounces 
of the seeds, beaten up in an emulsion of sugar and water, 
or honey, should be given. Occasionally, 15.0 gms. (Bi) of 
the expressed oil is given. It should always be followed by a 
cathartic several hours later. 

Preparations 
Pepo or Pumpkin Seeds 30.0-120.0 gms. gi-iv 

KAMALA 

Kamala is a reddish brown powder consisting of the 
minute glands and hairs from the capsules of Mallotus 
philippensis, an East Indian shrub. Its active principles are 
two resinoid substances, kamalin and rottlerin. 

ACTION 

Kamala destroys the tape worms and causes profuse di- 
arrhoea so that no cathartic is necessary after its use. 

Preparations 

About 4.0-8.0 gms. (5i-ii) of the powder is given in syrup, 
and repeated in two hours if the bowels do not move. A 
tincture of kamala is also occasionally given. 

TURPENTINE 

Turpentine destroys tape worms and round worms. It is 
given in doses of 30.0 gms. fgi) with twice its amount of 



ANTHELMINTICS 181 

castor oil. It is also given in very small doses, together with 
other anthelmintics. It is very apt to cause poisonous 
symptoms and is therefore not frequently used. 

LUMBRICIDES 

Lumbricides are drugs which destroy round worms. 
Round worms are small cylindrical worms which are often 
found in the small intestine of children. 



SANTONICA (LEVANT WORM SEED) 

Santonica or levant worm seed is the dry unopened flower 
heads of the Artemisia pauciflora, a plant growing in Asia 
Minor. Its active principle is a crystalline substance called 
santonin, though it also contains a similar substance called 
artemisin and a volatile oil, cineol. 



ACTION 

Santonin has a bitter taste and is partly dissolved in the 
stomach. Here some of it is absorbed into the blood. Most 
of the santonin then passes out into the small intestine, where 
it destroys round worms, or ascaris lumbricoides. 



Action after Absorption 

The absorption of some of the santonin, causes, in many 
cases, a very characteristic and peculiar disturbance of vision 
known as xanthopsia, or " yellow vision." 

At first all objects seem to have a blue color, but this ef- 
fect lasts for a very short time, and is soon followed by a con- 
dition where all objects seem to have a yellow tint; thus, blue 
seems green; and violet cannot be seen at all. This condition 
lasts for several hours and is probably due to a direct poison- 
ous effect on the retina of the eye. Occasionally there are 
also disturbances of the sense of taste, smell, and hearing. 

Santonin is excreted by the urine, to which it gives a 
characteristic yellow or reddish color. 



182 MATERIA MEDICA 



Poisonous Effects 



Overdoses of santonin not infrequently cause poisonous 
symptoms, especially in children. 

Symptoms 

1. '^ Yellow vision.'^ 

2. Twitchings of the muscles of the head. 

3. Rolling of the eyes, and grinding of the teeth. 

4. Various movements of the head, forward and back- 
ward, and from side to side. These sjrmptoms are soon 
followed by: 

5. Convulsions. 

6. Slow, irregular breathing, especially during the con- 
vulsions. 

7. Collapse (slow, weak pulse, moist, cold skin, dilated 
pupils, etc.). 

8. Occasionally nausea and vomiting, or loss of speech 
(aphasia), occur. 

Treatment 

The stomach should be washed out; emetics and cathartics 
are given. The convulsions are treated with chloroform or 
ether. 

Preparations 

Santonin, the active principle, is the drug which is prin- 
cipally used. 

Santonin 0.03-0.3 gm. grs'. §-v 

(Santoninum) 

For a child 2 years old 0.015 gm. (gr. |) should be given. 

Troches of Santonin 1-5 

(Trochisci Santoninae) 

Each contains 0.03 gm. (gr. J) of santonin. 
For a child, only 1 should be given. 

SPIGELIA (PINK ROOT) 

Spigeha or pink root is the root of the Spigelia marilandica, 
or Carolina pink, a plant growing in the southern United 
States. 



ANTHELMINTICS 183 

ACTION 

Spigelia is used to remove round worms. As it does not 
destroy the worm, it must be followed by a brisk cathartic. 

Poisonous Effects 

Overdoses of spigelia have occasionally produced the 
following symptoms, especially in children: 

1. Dry, flushed skin. 

2. Puffiness and swelling of the face. 

3. Rapid pulse, delirium and stupor. 

4. Dimness of vision or temporary blindness. 

Preparations 

Fluidextract of Spigelia 4.0-8.0 c.c. 5i-ii 

(Fluidextractum Spigeliae) 

For a child, 0.6 c.c. (m. x) is given on a piece of sugar, 
often together with senna. 

AZEDARACH 

Azedarach is the bark of the root of Melia azedarach, 
or the pride of China, an Eastern plant. 

It is used in the South as a remedy for round worms. 
It is usually given as a decoction, made from 5ii of the 
plant to a half pint of water, of which 15.0 c.c. or §ss is 
given every two hours. It is said to produce the same 
poisonous effects as spigelia. 

CHENOPODIUM (not official) 

Chenopodium or American worm seed, is the fruit of the 
Chenopodium ambrosioides, or Jerusalem oak, an American 
plant. Its active principle is a volatile oil, which has an 
extremely unpleasant odor. 

ACTION 

Chenopodium is used principally as a remedy for round 
worms. It is also used for the treatment of pin worms and 



184 MATERIA MEDICA 

tape worms. It is now being successfully used as a remedy 
for hookworm disease. 

Administration 
Chenopodium is very constipating. Consequently a dose 
of castor oil or a saline purgative should be given in the 
morning of the day before giving chenopodium. The pa- 
tient should be kept on a liquid diet all that day. The fol- 
lowing morning another dose of castor oil or a saline pur- 
gative is given. An hour later a capsule containing 0.3-0.6 
c.c. (mv-x) of an emulsion of chenopodium is given and 
the dose is repeated two and four hours later. Three hours 
after the last dose a dose of castor oil containing about 1.0 
to 2.0 c.c. of chloroform water is given. No food is given 
for the rest of the day. The treatment is repeated every 
week until the patient is cured. 

) Poisonous Effects 

\ Poisoning from chenopodium is not uncommon. The 

nurse should watch for persistent drowsiness which is usually 

the first symptom. 

Symptoms 

1. Drowsiness. 

2. Nausea and vomiting. 

3. Diarrhoea with stools containing blood and mucus. 

4. Mental depression. 

5. Great weakness. 

6. Collapse. 

7. Convulsions and paralyses. 

Preparations 
Oil of Chenopodium 0.2-0.3 c.c. m. iii-v 

(Oleum Chenopodii) 

It is usually given on sugar or in an emulsion. 
Senna and Calomel are also frequently used to remove 
round worms. 

DRUGS WHICH DESTROY THREAD WORMS 

Thread w^orms are small cylindrical worms which often 
inhabit the large intestine. The patients suffering from these 



ANTHELMINTICS 185 

worms are usually treated by enemata of the following sub- 
stances : 

1. Quassia 4. Tannic Acid 

2. Alum 5. Calumba 

3. Sodium Chloride 6. Lime Water 

7. Vinegar 

DRUGS WHICH DESTROY HOOK WORMS 

Hook worms, uncinaria americana, or anchylostoma duode- 
nale, are small cylindrical worms which frequently inhabit 
the small intestine or duodenum. 

Many people in the Southern United States, Switzerland 
and Egypt suffer from these worms, which cause a very 
severe form of anaemia. 

The following drugs are used to destroy hook worms: 

THYMOL 

Thymol is a stearoptene resembling carbolic acid chem- 
ically, which is obtained by evaporating the oil of thyme. 
This is a volatile oil obtained from Thymus vulgaris and 
other similar herbs which are found in most countries. 

ACTION 

Thymol produces the following effects : 

1. It acts as an antiseptic on the skin and mucous mem- 
branes. 

2. It checks the growth of bacteria in the intestines; 
thereby lessening fermentation. 

3. It is said to lower temperature, and it produces per- 
spiration. 

It is used principally as an antiseptic gargle and mouth 
wash and as an intestinal antiseptic. 

Thymol is extensively used as a remedy for Hookworm 
disease for which it is almost a specific. Hookworm disease 
is a very prevalent disease in the South. It is due to the 
presence of hookworms in the intestinal tract. The disease 
is characterized by severe anaemia, laziness, mental dull- 



186 MATERIA MEDICA 

ness, retardation of growth and perverted appetites (loss of 
appetite, the eating of chalk, hair, or clay). The Chalk 
Eaters in the South suffer from Hookworm Disease. 

The parasite usually enters the body from the ground, 
through the skin between the toes or the palms of the feet. 
At the site of entry they form characteristic pustules the 
so-called ^'ground itch" pustules. 

Thymol is also used as a remedy for Trichinosis, a disease 
produced by a parasite, the Trichina Spiralis lodging in the 
muscles. The parasite enters the body from the intestinal 
tract. In this disease it is given hypodermically in doses of 
0.12-0.2 gm. (grs. ii-iii) in olive oil every day. 

Administration 

The following method of giving thymol is the one adopted 
by the United States Public Health Service in its extensive 
campaign for the eradication of Hookworm Disease in the 
South. 

1. Give a dose of Magnesium Sulphate the night 
before. 

2. At 6 A. M. the following morning give 1.0-2.0 gm. 
(grs. xv-xxx) in 0.3 gm. (grs. v) capsules mixed with milk 
sugar or sodium bicarbonate. 

3. At 10 A. M. another dose of Magnesium sulphate 
should be given. 

The dose for children is half the adult dose given in the 
same manner. 

Poisonous Effects 

Poisoning from Thymol is not uncommon. The symptoms 
are principally ringing in the ear, nausea, vomiting, and col- 
lapse. 

Calomel, oil of chenopodium naphthol and magnesium sul- 
phate are also frequently used to destroy hook worms. 



PART III— DRUGS USED PRINCIPALLY FOR THEIR EF- 
FECTS UPON THE BLOOD AND CIRCULATION 

CHAPTER XI 

HAEMATINICS 

BLOOD STIMULANTS OR TONICS 

Physiology of the Blood 

The blood is a thick red fluid, which supplies all the vari- 
ous tissues and organs of the body with nourishment and 
oxygen. It also takes away all the waste products, result- 
ing from their various activities. These waste products are 
brought to the lungs, kidneys and intestines where they are 
excreted. 

The blood consists of a straw colored fluid (plasma) in 
which float sm.all round cells called corpuscles. The cor- 
puscles are of two kinds : red corpuscles and white corpuscles, 
or lecucocytes. 

The red corpuscles contain a protein substance, haemo- 
globin, which contains iron and which imparts the red color to 
them. 

This haemoglobin of the red corpuscles takes up oxygen 
from the air in the lungs; and brings it to the various organs 
of the body where it is used up by their various activities. 

The white corpuscles, together with the plasma act as 
cleansers of the blood. They destroy bacteria in the blood 
and help to neutralize their poisons by the formation of an- 
tidotes. The white corpuscles then bring these dead bacteria 
to the kidneys, intestines and other organs for excretion. 

Formation of Blood 

The plasma is formed from the digested food, which 
passes through the lining membrane of the intestines into 
the blood vessels. Some of the plasma formed from the 

187 



188 MATERIA MEDICA 

digested food first enters the lymphatic vessels^ from which 
it finally reaches the blood stream. 

The red and white corpuscles are formed in the bone 
marrow and spleen. The haemoglobin is formed in the 
liver and spleen. 

Effects of Drugs on the Blood 

Drugs affect the blood in two ways : 

1. They may increase the amount, or improve the quality, or 
both (stimulation.) 

2. They may lessen the amount, or deteriorate the quality 
of the corpuscles and plasma (depression). 

Stimulation of the blood occurs: 

a. When drugs increase the amount of plasma and the 
number of red or white corpuscles, or both. 

b. When they improve the quality of the corpuscles, for 
example, by increasing the amount of haemoglobin. 

Depression of the blood occurs: 

a. When drugs lessen the amount of blood by withdrawing 
some of the fluids. 

b. When they reduce the number of corpuscles. 

c. When they combine with the haemoglobin so that it 
is unable to take up oxygen from the air in the lungs. 

In this chapter we shall consider only those substances 
which improve the condition of the blood (blood stimulants). 

NORMAL SALT SOLUTION 

In cases where a patient has lost a considerable amount 
of blood, life may be endangered, because there is not suf- 
ficient blood in the body for the heart to pump. The heart 
beats then become very weak, slow or rapid, and the pulse 
is weak, slow and soft. 

To keep the heart beating, until new blood can be formed, 
to make up for ihe amount lost, salt solution of a definite 
strength is often injected into a vein, or into the muscles. 
This keeps the heart beating, thus maintaining the circulation 
of the blood. 



HAEMATINICS 189 

The percentage of salt (sodium chloride) used, is a 0.9% 
solution, or 9 parts of salt to a thousand parts of water. 
Such a solution is called a normal salt solution. 

A salt solution of this strength does not destroy the red 
corpuscles of the blood and is called an isotonic solution. 
If a fluid weaker than this percentage is injected into the 
blood, the red corpuscles are destroyed. Such a solution 
is called a hypotonic or anisotonic solution. If a stronger 
percentage of salt solution than 0.9% is used, the blood 
corpuscles are shrunk (crenated). Such a solution is called 
a hypertonic solution. 

The strengths usually given for normal salt solution vary 
from 0.6-0.9%. Different percentages are often used for 
different purposes. We may readily understand the varia- 
tion in the strengths usually given for normal salt solution, 
by reviewing the essential facts regarding the salts of the 
blood. 

The blood contains various salts. Of these salts 0.6% is 
sodium chloride or table salt; and the others, which are 
principally potassium chloride and calcium chloride, com- 
prise 0.3%. A solution which contains these salts in the 
percentages in which they occur in the blood best maintains 
the integrity of the corpuscles. Such a solution is called 
Ringer's solution, and is frequently used in laboratory work. 
It is now coming into use in practical medicine. The in- 
tegrity of the corpuscles, however, may also be maintained 
by any salt solution which contains 0.9% of salt. For prac- 
tical purposes we therefore use such a solution of sodium 
chloride or ordinary table salt. This may be prepared by 
adding 8.0 gms. or 5ii of sodium chloride to a quart of sterile 
water, thus preparing a normal salt solution. 

Frequently we use a 0.6% solution of salt or sodium 
chloride, especially when other medicines are to be added to 
the solution which may tend to increase its isotonic power 
(the power of maintaining the integrity of the corpuscles). 
Since such a salt solution contains the exact physiological 
quantity of sodium chloride as the blood, it is better to call it 
a physiological salt solution. 

In preparing normal salt solutions it is better to use 



190 MATERIA MEDICA 

ordinary table salt and plain undistilled sterile water. 
Both contain minute quantities of calcium which tends to 
prevent the undesirable effects that occasionally result from 
the sodium. 

RINGER'S SOLUTION 

Ringer's solution is a solution containing the exact salts 
of the blood in the same percentages as they occur in the 
blood. It is used in the same way as normal salt solution but 
it is preferable to it because it contains all the salts found 
in the blood as follows : 

Calcium chloride 0.02% 

Potassium chloride 0.02% 

Sodium chloride 0.9 % 

Sodium bicarbonate 0.01% 

Ringer's tablets are tablets containing the salts found in 
the blood which make a Ringer's solution when dissolved 
in a definite quantity of water. The following is the formula 
of the Ringer's tablet: 

Calcium chloride 0.05 gm. 

Potassium chloride 0.05 gm. 

Sodium chloride 2.25 gms. 

Sodium bicarbonate 0.025 gm. 

Another tablet contains Dextrose 0.25 gm. in addition 

When one of these tablets is dissolved in 250 c.c. of water 
it forms a Ringer's solution. 

Methods of Administration 

1. Intravenous Infusion: This is the quickest method for 
getting normal salt solution into blood. 

The solution is injected into the median basilic, or into the 
median cephalic vein of the forearm, by means of a special 
apparatus which is held about two feet above the patient. 
The salt solution is allowed to run through a long rubber 



HAEMATINICS 191 

tube and cannula, the cannula being inserted into the vein 
in a direction toward the heart. 

2. Hypodermoclysis : This is a slower method of getting 
normal salt solution into the blood. 

The solution is allow^ed to run in underneath the breasts, 
or into the thighs, through a large needle which is inserted 
into these regions. The needle is attached to a rubber tube 
connected with a bottle which contains the salt solution. 
The fluid is absorbed into the blood from the tissues under- 
neath the breasts ; or from the thighs. 

3. Rectoclysis, or Murphy Method: This method consists 
in allowing the solution to run into the rectum, drop by drop, 
through a catheter. This is attached by a long rubber tube, 
to a receptacle containing salt solution, which is held a few 
feet above the level of the bed. When the solution enters 
the rectum it is absorbed into the blood through the rectal 
mucous membrane. 

Effects 

After an intravenous infusion, or a hypodermoclysis of 
salt solution, the heart usually beats stronger and faster, 
the pulse is stronger, faster and more bounding in quality; 
and the blood pressure is increased. The patient breathes 
faster and deeper and feels brighter. 

Transfusion 

Occasionally, when a patient has lost a great deal of 
blood, blood from another individual is injected into one 
of his veins. This is done by sewing an artery of the 
healthy individual to the vein of the patient; and allow- 
ing the blood from the donor to flow into the patient's veins, 
for about an hour. The effects produced are the same as 
those following an infusion, but they are more lasting. 

Recently a method of transfusion has been devised 
whereby blood is withdrawn from one of the veins of a 
healthy individual, and sodium citrate is added to it to 
prevent its clotting. This prepared blood is then injected 
into one of the veins of the patient. 



192 MATERIA MEDICA 



SODIUM CITRATE 



Sodium citrate is noAv extensively used in preparing blood 
for transfusion. It prevents the clotting of the blood by 
combining chemically with the calcium salts. About 10 c.c. 
of a 2% solution is added to every 100 c.c. of blood taken 
from the donor. It also comes in sterile glass ampoules each 
containing 10 c.c. of a 2% solution. 



SUBSTANCES USED TO INCREASE BLOOD CLOTTING 

Physiology of Clotting of the Blood 

Blood has the peculiar property of changing from a liquid 
to a gelatinous solid state when it is removed from the blood 
vessels. This property of clotting prevents a serious loss of 
blood from haemorrhage. The formation of a clot in the 
opening of the bleeding vessel acts as a plug to prevent fur- 
ther loss of blood. If blood is allowed to stand for a short 
time after it has clotted it separates into two parts: a clear 
straw colored liquid, at the bottom of which is the dark red 
gelatinous clot. 

Microscopic examination of the solid part of the clot re- 
veals that it consists of a mass of red and white blood cells 
held together by a network of fibrin. 

Three factors are necessary to enable blood to clot: cal- 
cium salts, fibrin ferment and contact with any substance 
other than the w^alls of the blood vessels. The fibrin net- 
work exists in the blood dissolved in the serum. In this 
dissolved state it is called fibrinogen. This fibrinogen is 
changed to fibrin by the action of a ferment thrombin. This 
ferment exists in the blood in the form of prothrombin which 
is changed into thrombin by the action of calcium salts 
and a substance called thrombokinase or thromboplastin. 
Thromboplastin is only formed during bleeding from the 
injured tissue, from the blood cells and from the blood 
platelets. 



HAEMATINICS 193 

Fibrin Ferments and Thromboplastic substances 

The following group of substances are used to aid the 
clotting of blood. All the tissues which form thromboplastin 
contain a fatty like substance (lipoid) called kephalin which 
is found in brain tissue. Consequently various preparations 
have been made from a number of tissues containing kepha- 
lin which therefore contain thromboplastin and have the 
property of clotting blood. 

Uses 

Thromboplastin or substances containing it are applied 
locally on gauze sponges to bleeding points to check haemor- 
rhage. They are also used hypodermically or intravenously 
in 0.1 to 0.2% solutions in normal salt solution to check 
internal haemorrhage. 

Thromboplastin preparations should not be used in dis- 
eases where the coagulation of blood or the formation of 
clots is detrimental as in heart disease, aneurysm, etc. 

Preparations 
Kephalin 

This is a substance prepared from chopped up ox brains 
which contains thromboplastic substances. 

Solution of Brain Extract 

This is an extract of cattle brains containing thrombo- 
plastic substances. It comes in ampoules each containing 
25 c.c. 

Thromboplastin solution 

This is the same as solution of brain extract. 

Coagulen (Ciba) 

This is an extract prepared from blood platelets contain- 
ing thromboplastic substances. 

The preparations are usually yellowish granular powders 
which dissolve readily in water. They come in tablets of 
0.5 gm. (grs. viii) with 0.46 sodium chloride. They also 



194 MATERIA MEDICA 

comes in 1.5 c.c. ampoules each containing a 3% solution, 
for hypodermic use and in 20 c.c. solutions for local use. 

The solutions must always be fresh. They are prepared 
by dissolving in normal salt solution and boihng for three 
minutes. 

Calcium salts in large doses are usually given to aid the 
clotting of blood (see page 125). 

IRON (FERRUM) 

Iron is a heavy metal; many of its preparations are used 
as drugs. Many food substances, such as meat, eggs and 
some vegetables, contain a great deal of iron. In the body, 
iron is found principally in the haemoglobin of the blood; 
about one part of iron to 230 parts of corpuscles. 

ACTION 

Local Action: On the skin, iron causes no effect, but if 
it is applied to a bleeding surface, it stops the bleeding, by 
precipitating (hardening) the albumins of the blood, which 
then close up the bleeding vessel. Mucous membranes are 
contracted by preparations of iron (astringent action). 

Internal Action 

In the mouth: Iron has a distinct metallic taste, and 
shrinks the lining membrane of the mouth, making it feel 
dry. It also discolors the teeth, if used continually. 

In the stomach: It contracts the lining membrane and 
occasionally causes nausea. 

In the intestine : It contracts the lining membrane, check- 
ing the secretions, thereby producing constipation. 

Action after Absorption 

Part of the iron taken as food or as a medicine is slowly 
absorbed from the duodenum, the first part of the small 
intestine. It is then carried to the spleen, where it is stored 
up for future use; and to the liver, where it helps to form 
haemoglobin for the red blood corpuscles. If iron is taken 



HAEMATINICS 195 

for any length of time, more haemoglobin is formed. The 
red blood corpuscles of the blood therefore contain more 
haemoglobin. They are then bettt^r able to take up more 
oxygen from the air in the lungs, and to supply the various 
organs and tissues of the body with more oxygen, which 
enables these organs to perform their work better. In ex- 
change for the oxygen the corpuscles remove the carbon 
dioxide that results from the activities of the organs and 
tissues. 

As a result of these effects, the contractions of the heart 
are improved; because the heart muscle itself is supplied 
with more oxygen. The patient is able to breathe deeper, 
and thus inhales more air (and therefore more oxygen) be- 
cause the muscles for breathing, such as the diaphragm, are 
supplied with more oxygen. The breathing center in the 
brain, also sends more impulses for breathing; because it 
too, is supplied with better nourishment. The food is di- 
gested better; because the stomach, the salivary and pan- 
creatic glands secrete more digestive juices, as a result of 
being supplied with better blood that contains more oxygen. 

The muscles contract better, because they, too, are sup- 
plied with better blood, containing more oxygen. 

The brain acts better, the patient is brighter, is more in 
harmony with his surroundings, because the brain is sup- 
plied with blood containing more oxygen. 

All the organs of excretion, such as the kidneys, the 
lungs and skin, eliminate waste products better and quicker, 
because these organs are supplied with better blood and 
are able to do their work better. 

Appearance of the Patient 

As a result of the improved activity of all the organs of 
the body, the patient feels brighter, is more active, and more 
robust. He looks better, has a ruddier color, his appetite 
is better, and he digests his food better. 

A drug which improves the general condition of the 
patient in this manner, is called a tonic. 

The effects do not appear after a few doses, but result 
from continued administration of iron. 



196 MATERIA MEDICA 

Excretion 

Only part of the iron taken as a medicine, or in the food, 
is absorbed. The rest is excreted by the intestines, in the 
stools. On account of the large amount of iron present 
in the stools, the lining membrane of the intestines is con- 
tracted, and constipation results. 

Uses 

Iron is used principally in cases of anaemia, a condition 
in which the patient's blood is very poor. For example — ■ 
when the patient has lost a great deal of blood, or when he is 
suffering from some chronic disease, such as tuberculosis or 
cancer. It is used with best results in a peculiar kind of 
anaemia, occurring in young girls, called chlorosis. 

Poisonous Effects 

In some cases, after continued use of iron for any length 
of time, it produces the following symptoms: frontal head- 
ache, loss of appetite, pain in the pit of the stomach, occa- 
sionally nausea a^nd vomiting, colic and invariably constipa- 
tion. Sometimes the skin becomes covered with very small 
pustules (acne). 

The condition is reheved by stopping the iron, and giving 
cathartics. 

Administration 

In giving iron, the nurse should remember the following 
rules : 

1. Iron should always be given after meals, well diluted, 
in an albuminous fluid such as milk. 

2. To avoid discoloring the teeth, iron should always be 
given through a glass tube or a straw, so that the drug does 
not touch the teeth. 

3. To avoid constipation, the bowels should be moved 
regularly with some cathartic, or a preparation of iron 
should be given which contains a cathartic. 

4. If a gargle containing iron is given, the teeth should be 
brushed and the mouth then rinsed with salt water aftei? 
each administration. 



HAEMATINICS 197 

5. Silver spoons are stained by iron; they should never 
be used in giving any of the preparations. Strong ammonia 
water removes these stains. 

6. Iron stains clothing, sheets, carpets, etc. Oxalic acid 
removes these stains. 

Preparations 

There are a great many preparations of iron, but only the 
most important ones follow: 

There are several preparations of iron which are only 
used for their local effects or to check bleeding. 

For internal use there are two kinds of preparations: 
inorganic and organic. 

The inorganic preparations are metallic salts of iron. 

The organic preparations are preparations of iron com- 
bined with various kinds of proteins, such as egg albumin. 

The organic preparations do not contract mucous mem- 
branes as much as the inorganic ones; and are, therefore, not 
so apt to cause unpleasant symptoms after continued use. 

Preparations for Local Use 

Solution of Iron Sub sulphate 0.2-0.6 c.c. m. iii-x 

(Liquor Ferri Subsulphatis) 
(Monsell's solution) 

This preparation contains about 13% of iron. 

Iron Chloride 
(Ferri Chloridum) 

This preparation is used in a 20% solution, or the pure 
crystals are allowed to take up moisture from the air by 
being exposed (deliquescent action), and are then used. 

These two preparations are principally used to stop bleed- 
ing or to contract mucous membranes, either by local appli- 
cation, or in the mouth as a gargle. 

Iron Sulphate 0.03-0.3 gm. grs. J-v 

(Ferri Sulphas) 
(Green vitriol) 

This is seldom used internally, but it is used to contract 



198 MATERIA MEDICA 

mucous membranes and check bleeding. It is also used as a 
disinfectant for privies or drains. 

Preparations for Internal Use 
Inorganic Preparations 
Solids 
Pills of Iron Carbonate 1-5 pills 

(Pilulae Ferri Carbonatis) 
(Blaud's pills) 

These pills consist of iron sulphate, the carbonate of 
sodimn or potassium, tragacanth, sugar and glycerin. 

Each pill contains about 0.06 gm. (gr. i) of iron. 

These pills should always be fresh. Old pills may pass 
through the intestines without causing any effects^ or with- 
out being changed in any way. 

Reduced Iron 0.06-0.12 gm. grs. i-ii 

(Ferri Reductum) 
(Quevenne's Iron) 

This is a brown powder which is tasteless and does not 
contract mucous membranes. It is often given to children 
in candy. 

Soluble Iron Phosphate 0.06-0.3 gm. grs. i-v 

(Ferri Phosphas Solubilis) 

Iron Citrate 0.06-0.3 gm. grs. i-v 

(Ferri Citras) 

Pills of Iron Iodide 1-3 pills 

(Pilulae Ferri lodidi) 

Each pill contains 0.03 gm. (gr. \) of reduced iron, also 
iodine, acacia, licorice and balsam of tolu. 

Iron and Strychnine Citrate 0.1-0.3 gm. grs. ii-v 

(Ferri et Strychninae Citras) 

This contains 1% of strychnine and 16% of iron. 

Iron and Quinine Citrate 0.3-0.6 gm. grs. v--x 

(Ferri et Quininae Citras) 

This contains 12% of quinine and 15% of iron. 



HAEMATINICS 199 

Solid Preparations Combined with Cathartics 

Iron and Potassium Tartarate 0.3-0.6 gm. grs. v-x 
(Ferri et Potassii Tartaras) 

This contains 15% of iron. 

Pills of Aloes and Iron 0.2-0.5 gm. grs. iii-viii 

(Pilulae Aloes et Ferri) 

This contains dried iron sulphate and aloes. The aloes 
overcomes the constipating effect. It is often used in cases 
of scanty menstruation or absence of menstruation (amen- 
orrhoea), in chlorosis. 

Fluid Preparations 

Solution of Iron Tersulphate 
(Liquor Ferri Tersulphatis) 

This contains 10% of iron. 

It is only used in making up other preparations, especially 
the antidote for arsenic. 

Tincture of Iron Chloride 0.3-2.0 c.c. m. v-xxx 

(Tinctura Ferri Chloridi) 

(Muriated tincture of iron) 

This is one of the best preparations of iron, and is very 
frequently used. It contains about 4% of iron in alcohol. 

It is best given in milk or in glycerin, 3 parts of the prep- 
aration to one of glycerin, (to prevent constipation) or in 
egg albumin, to prevent its blackening the teeth. 

Solution of Iron and Ammonium 

Acetate 15.0-30.0 c.c. 5H 

(Liquor Ferri et Ammonii Acetatis) 

(Basham's mixture) 

This preparation contains very little iron and must be 
freshly made. It consists of the tincture of iron chloride, 
dilute acetic acid, solution of ammonium acetate, elixir 
of orange, glycerin and water. 

Syrup of Iodide of Iron 0.3-2.0 c.c. m. v-xxx 

(Syrupus Ferri lodidi) well diluted 



200 MATERIA MEDICA 

This is an excellent preparation especially for children. 
It contains about 2% of iron. 

Compound Iron Mixture 15.0-120.0 c.c. § J-iv 

(Mistura Ferri Composita) 

(Griffith's mixture) 

This preparation contains iron sulphate, potassium car- 
bonate, myrrh, sugar and spirits of lavender. 

Elixir of Iron, Quinine and Strychnine Phosphate 
(Elixir Ferri, Quiniae, et Strychniae Phosphatum) 

This preparation is very frequently used as a tonic. It 
contains about 2% of iron phosphate. 

Each teaspoonful dose contains J grain of iron phosphate 
and quinine and ^\ grain of strychnine. 

Syrup of Iron, Quinine and Strychnine Phosphate 
(Syrupus Ferri Quininae et Strychninae Phosphatum) 

4.0-8.0 c.c. 3i-ii 

This preparation contains 9% of iron phosphate. Each 
teaspoonful dose contains grs. v of iron phosphate, -h grain 
strychnine and IJ grains of quinine. 

Antidotes for Arsenic 
Iron Hydroxide 
(Ferri Hydroxidum) 

This preparation is used principally as an antidote for 
arsenic poisoning. About 8 grains of it will neutrahze 1 grain 
of arsenic. It must always be fresh. 

If iron hydroxide is not on hand, it can be made from the 
tincture of iron chloride, by adding ammonia water or 
sodium carbonate to it. A precipitate (sediment) will then 
form. Enough ammonia or sodium carbonate must be 
added until no more sediment forms. The sediment is then 
washed and strained, and given in milk; as often as is neces- 
sary to neutralize the arsenic. 

Iron Hydroxide with Magnesia Oxide 15.0-30.0 gms. 5j-i 
(Ferri Hydroxidum cum Magnesii Oxido) 

This is made from iron sulphate, to which magnesia is 
added. It is the best antidote for arsenic poisoning. 



HAEMATINICS 201 

Dialyzed Iron (not official) 1.3-2.6 c.c. m. xx-xl 

(Ferri Dialysatum) 

This is a preparation of iron which is frequently used as 
an antidote for arsenic poisoning. It is also used in the 
treatment of anaemia. 

ORGANIC IRON PREPARATIONS 

The following preparations of iron are made with organic 
substances such as proteins (albumins, peptones, etc.) . They 
have no advantage over the other preparations of iron, ex- 
cept that they are more readily absorbed, and do not con- 
tract mucous membranes as much as the inorganic prepara- 
tions. Most of them are not official. 

Solid Preparations 
Iron Tropon (not official) 4.0-8.0 gms. 3i-ii 

This is a preparation of iron with protein, flavored with 
chocolate. 

Haemogallol (not official) 0.25-0.5 gm. grs. iv-viii 

This is an organic iron preparation made from blood. 
Ferratin (not official) 0.5 gm. grs. vii^ 

This substance is made from egg albumin and iron. 
Ferrous Lactate (not official) 0.06-L2 gm. grs. i-xx 

It is best given in syrup. 
Triferrin 0.3 gm. grs. v 

This is an organic compound of iron. 
Proferrin 0.06-0.3 gm. grs. i-v 

This is a compound of iron with nucleoprotein. 

Fluid Preparations 
Ferro Mangan (not official) 4.0-16.0 c.c. 3i-5|- 

This is a solution of iron, manganese and peptones^ 
There are several other similar preparations under various 
names, such as peptomanganate of iron, etc. 
Ovoferrin (not official) 8.0-16.0 c.c. 3ii-iv 



202 MATERIA MEDICA 

This is a preparation made from serum albumin and iron 
by an electrical process. 

Haemaboloids 15.0 c.c. $i 

(Not official) 

This is a compound of iron, proteins and bone marrow. 
The following are the most efficient and most frequently 
used preparations of iron : 

Blaud's Pills 

Tincture of Iron Chloride 
Syrup of Iodide of Iron 
Basham's Mixture 

and a number of the organic preparations. 

Incompatibilities of Iron 

The following drugs cannot be given together with iron 
because they form chemical compounds with it: 

Preparations of iron should never be given with tea^ 
or with vegetable drugs containing tannin or tannic acid, as 
iron combines with these drugs and forms ink. 

The alkaline preparations of iron should not be given 
with acids. For example — do not give Basham's mixture 
together with dilute acids, as they combine and form a 
sediment. 

The iron salts of the mineral acids should not be given 
with alkahes. For example — do not give tincture of iron 
chloride with sodium bicarbonate, as they will combine 
and form a sediment. 

MANGANESE (MANGANUM) 

Manganese is a metal. Many of its preparations are 
occasionally used in medicine. It is foimd in the body in the 
red blood corpuscles, the hair and bile, usually together with 
iron. Some of its preparations, especially potassium perman- 
ganate, is used as an antiseptic. 

It is said to increase nutrition and is frequently given 
together with iron. It cannot replace iron, however, as it does 
not help to form haemoglobin. 

Manganese Sulphate 0.1-0.5 gm. grs. ii-viii 

(Mangani Sulphas) 



HAEMATINICS 203 

Manganese Hypophosphate 0.2 gm. grs. iii 

(Mangani Hypophosphis) 

Potassium Permanganate 0.03-0.15 gm. gr. J-iii 

(Potassii Permanganas) 

This preparation gives off oxygen; it is often given in 
cases of poisoning from various drugs. For example — in 
morphine poisoning it is given to neutralize the morphine by 
the oxygen which the potassium permanganate hberates, 
which then combines with the drug and makes it inactive. 

It is also used as an antiseptic, acting in a similar manner, 
the oxygen destroying the bacteria. 

There are a number of unofficial preparations of iron 
which are combined with manganese. 

ARSENIC 

Arsenic is a metal which is commonly used in the manu- 
facture of dyes and other commercial products. 

It is one of the oldest drugs in medicine, and was very 
frequently used for criminal poisoning during mediaeval 
times. There are a number of compounds of arsenic, but only 
one group of them is used in medicine. These are the com- 
pounds of arsenic trioxide, white arsenic or arsenious acid. 

Appearance of the Patient 

When small doses of arsenic are given for some time, 
the patient feels better, stronger and is more active. He 
looks more robust, somewhat stouter and has a ruddier color. 
The appetite is better and the bowels move more often. 
The pulse is stronger, somewhat faster and the patient 
breathes somewhat deeper. In short, the patient feels 
better and stronger. 

ACTION 

Local Action: Applied to the skin, arsenic causes inflamma- 
tion and pain. If it is allowed to remain on the skin for a 
longer time, the skin is destroyed and an ulcer remains 
(escharotic or caustic action). Arsenic is slightly antiseptic. 



204 MATERIA MEDICA 

It is easily absorbed from the injured skin. On mucous mem- 
branes, when appUed locally, it also causes redness and pain, 
with subsequent inflammation and destruction of the tissues. 

Internal Action 

In the mouth, arsenic has a sweetish taste, causes redness 
of the lining membrane of the mouth, and increases the flow 
of saliva. 

Arsenic affects principally the stomach and intestines 

In the stomach it causes a sense of heat, it increases the 
appetite and the secretion. 

In the intestines, it increases the secretion of the mucous 
membrane, and the peristalsis, thus causing movements of 
the bowels. 

Action after Absorption 

Arsenic is rapidly absorbed from the stomach and intes- 
tines, as well as from all the mucous membranes. After ab- 
sorption, it affects principally the blood and the tissues. 

Action on the Blood: Arsenic increases the number of red 
blood corpuscles by increasing their formation in the bone 
marrow. Since the red blood corpuscles in the blood are 
increased, they are able to carry more nourishment and more 
oxygen to the organs and tissues of the body, and to remove 
more waste products. Thus they increase the activity of all 
the organs of the body in the same way as iron does. 

The patient is then healthier, more robust, has a better 
appetite and feels better (tonic action). 

Action on the Tissues: Arsenic prevents the tissues from 
being used up, by lessening their combination with oxygen. 
It therefore increases the growth and nutrition of the tissues 
and organs of the body. As a result of this action, if arsenic 
is taken for some time, the patient usually becomes some- 
what stouter. 

Action on the Circulation: In the doses that arsenic is 
usually given, it makes the heart beat somewhat stronger, 
though the rate of the pulse is not much affected. This is the 
result of the improvement in the general condition. 



HAEMATINICS 205 

Action on the Respiration: By improving the general con- 
dition of the patient, the breathing is deeper and faster, 
the patient takes in more air, and therefore more oxygen 
for the larger number of corpuscles which the blood contains. 

Action on the Brain and Spinal Cord: The brain and 
spinal cord are somewhat more active, when arsenic is given 
for some time, because of the improvement of the general 
health. 

Excretion 

Arsenic is excreted mainly by the urine, also by the lining 
membrane of the stomach, intestines and bronchi. It is 
excreted very slowly and may therefore cause cumula- 
tive symptoms. 

Tolerance 

When arsenic is taken regularly in small quantities, the 
patients are able to take comparatively large quantities of 
the drug without getting poisonous effects. A patient is then 
said to have a tolerance for arsenic. This is due to lessened 
absorption which occurs from continued use. 

In some countries, for example in the Tyrol, the peasants 
eat large quantities of arsenic, because it enables them to do 
their work better, and to climb the mountains with less 
effort. It is said to improve their complexion. These peas- 
ants often live to a very old age. 

Women very often take arsenic for weeks or months at 
a time to improve their complexion and figure. Poisonous 
symptoms often occur as a result of such use. 

Uses 

Arsenic is used principally in anaemia, to improve the 
condition of the blood. It is used especially in those forms of 
anaemia in which the number of the corpuscles are dimin- 
ished. It is often given together with iron. 

Arsenic is also given for chorea (St. Vitus' dance), and as a 
tonic, to improve the general condition of the patient. Son?e 
of the newer preparations of arsenic are given as a specific for 
syphilis. 



206 MATERIA MEDICA 

Poisonous Effects 

There are two forms of arsenic poisoning: 

1. Acute arsenic poisoning. 

2. Cumulative arsenic poisoning. 

Acute Arsenic Poisoning 

This follows a single large dose of arsenic taken with 
suicidal intent or by mistake. Many rat and insect poisons 
contain large quantities of arsenic. 

Symptoms 

The following are the symptoms which occur in about 
fifteen minutes to an hour : 

1. Burning pain in the oesophagus and stomach. 

2. Profuse nausea and vomiting of bile stained serum 
containing small flakes of mucous membrane. 

3. Severe abdominal cramps. 

4. Profuse diarrhoea, with watery, bloody stools contain- 
ing small flakes of mucous membrane (rice water stools). 

5. Excessive thirst (due to loss of fluid). 

6. Scanty, bloody urine. 

7. Collapse: cold, moist skin, slow and shallow breathing, 
rapid, thready pulse, etc. 

8. Coma and convulsions may occur before death, which 
results in from six hours to two days. 

In some cases there may not be much nausea, vomiting or 
diarrhoea. The patient suddenly goes into collapse, has 
a few convulsions and dies. 

If the patient recovers from the acute symptoms, paralysis 
of the muscles of the extremities may result, causing ^^drop 
feet" or ^^drop hands," from which he usually recovers, 
however. 

Treatment 

1. Give iron hydroxide or iron hydroxide with magnesia 
until recovery. 

2. Wash out the stomach, thereby removing the com- 
pound of iron and arsenic. Induce vomiting if no stomach 
tube is at hand. 



HAEMATINICS 207 

3. Protect the mucous membrane of the stomach and the 
intestines by giving mucilaginous drinks such as milk, olive 
oil, etc. 

4. Give plenty of water. 

5. Later, bismuth, chalk or opium may be given for the 
diarrhoea. 

6. Abdominal cramps are usually relieved by a hot water 
bag and by atropine. 

7. The collapse is usually treated with caffeine, atropine, 
strychnine, warm applications, etc. 

Cumulative Arsenic Poisoning 
Since arsenic is excreted much slower than it is absorbed, 
cumulative symptoms, or chronic arsenic poisoning is very 
common. It usually occurs from the continued medicinal 
use of arsenic preparations. It may also result from in- 
haling fumes of arsenic, in rooms papered with wall paper 
containing arsenic dyes, from wearing clothing dyed with 
arsenic, or by eating food colored with arsenic dyes. The 
following symptoms, in the order of their onset, are noticed 
after prolonged administration. Often the later symptoms 
appear before the earlier ones. 

Symptoms 

1. Itching of the eyelids. 

2. Redness of the conjunctiva of the eye. 

3. Puffiness about the eyes, especially in the morning. 

4. Sneezing, ' 'running nose' ^ (coryza). 

5. Tightness in the throat. 

6. Hoarseness. 

7. Loss of appetite, heaviness in the stomach, nausea 
and vomiting. 

8. Skin eruptions; red spots, areas of brownish discolora- 
tion (very often they look like freckles) on the face or the 
abdomen. Dark discolorations on the skin of the abdomen, 
which look like pencil marks. 

In severe cases, the hair and nails may fall off. 

9. Cramp-hke abdominal pains. 



208 MATERIA MEDICA 

10. Diarrhoea^ with '^rice water" stools; the rice water 
appearance of the stools is due to small flakes of the lining 
membrane of the intestine which they contain. 

The following symptoms appear later and only in severe 
cases: 

11. Persistent headache. 

12. Pains around the knee, ankle, foot and hands. 

13. Redness and swelling of the hands and feet. 

14. Areas of skin, especially on the extremities, which are 
very sensitive to touch, to pain, to heat and cold. 

15. In severe cases there are paralyses of the extensor 
muscles of the hands and feet, resulting in ^'drop feet" and 
^Mrop hands." 

Treatment of Chronic Arsenic Poisoning 
If the arsenic is stopped and cathartics given, the symp- 
toms usually gradually disappear. The paralyses must be 
treated by massage and electricity, until the muscles recover; 
which they usually do. 

Preparations 
Fluid Preparations: 
Solution of Potassium Arsenite 0.06-0.5 c.c. m. i-viii 
(Liquor Potassii Arsenitis) 
(Fowler's solution) 

This contains 1% of arsenic trioxide, potassium bicar- 
bonate and tincture of lavender. 

Five minims of Fowler's solution contain gV g^"' ^^ arsenic 
trioxide. 

Solution of Sodium Arsenite 0.06-0.5 c.c. m. i-viii 

(Liquor Sodii Arsenitis) 
(Pearson's solution) 

Solution of Arsenious Acid 0.06-0.5 c.c. m. i-viii 

(Liquor Acidi Arsenosi) 

This contains 1% of arsenic trioxide and dilute hydro- 
chloric acid. 

Solution of Arsenious and Mercuric 

Iodides 0.1-0.3 c.c, m. 1\-y 

(Liquor Arseni et Hydrargyri lodidi) 
(Donovan's solution) 



Solid Preparations : 




0.001-0.005 gm. 


gr- -g'W2 


0.001-0.005 gm. 


gr. ?V-iV 


0.003-0.01 gm. 


gr. iir-l 


0.015-0.06 gm. 


gr. H 



HAEMATINICS 209 

This is the strongest arsenic preparation. It contains 1% 
each of arsenic iodide, and of red mercuric iodide. It may 
cause symptoms of mercury poisoning. 

Arsenic Trioxide 
(Arsenii Trioxidum) 

Sodium Arsenate 
(Sodii Arsenas) 
Arsenic Iodide 
(Arsenii lodidum) 

Sodium Cacodylate 
(Sodii Cacodylas) 

This is a compound of cacodyHc acid, which is a com- 
pound of arsenic. It is given hypodermically and is said to 
cause no unpleasant symptoms. 

Arsen Triferrin 0.3 gm. grs. v 

(unofficial) 
This a compound of iron, arsenic, phosphorus and albumin. 

Soamin (not official) 

This is sodium arsanilate, and contains 22% of arsenic. 
It usually comes in tablets each containing 0.06-0.3 gm. 
(grs. i-v) of soamin. 

Salvarsan ^^606" 0.3-0.6 gm. grs. v-x 

Neosalvarsan 0.3-0.6 gm. grs. v-x 

These are organic compounds of arsenic which are used 
as specifics for syphihs. They are given intravenously, 
as an intravenous infusion, or by deep injection into the 
muscles. Salvarsan has to be very carefully neutralized 
with an alkali. Both preparations come in closed glass tubes 
containing nitrogen gas and the powder. 

Atoxyl 

This is Sodium Arsanilate, and comes in tablets of 0.02 gm, 
(gr. -3) for hypodermic use. 



210 MATERIA MEDICA 

Administration 

Arsenic preparations should be given well diluted in a large 
glass of milk after meals. 

BENZOL 

Benzol is an oily colorless inflammable liquid made from 
coal tar. It is used in metal manufacturing as a solvent. 
The fact that very severe anaemias occur among such metal 
workers is responsible for its use in medicine for conditions 
where there is an increase in the number of blood cells. 

It is therefore used in the treatment of Leukeemia^ a 
progressive and fatal disease characterized by a marked in- 
crease in the number of leucocytes in the blood and a change 
in their character. Benzol causes destructive changes in 
the bone marrow where the blood cells are formed as a result 
of which the number of leucocytes diminish and the patients 
improve, but the improvement is not permanent however. 
It is given in doses of 0.5 to 1.0 c.c. in milk or olive oil. 

Benzol must not be confounded with benzine, an entirely 
different substance made from petroleum. 



CHAPTER XII 

CIRCULATORY STIMULANTS 

Physiology of the Circulation of the Blood 

The blood supplies all the organs and tissues of the body 
with nourishment and takes away their waste products. 
It reaches these organs and tissues, through numerous small 
elastic tubes, the arteries. These gradually divide into 
smaller branches so that the narrowest are called capil- 
laries. The blood is kept constantly flowing through these 
vessels by the rhythmic action of a complicated pump, the 
heart. 

The impure blood resulting from the action of the tissues 
and organs is being constantly brought back to the heart by 
means of a system of tubing called the veins. 

Physiology of the Heart 

The heart is a pear-shaped organ, about the size of one's 
fist, situated in the left side of the chest. It consists of four 
chambers. Two of these chambers receive blood into the 
heart from the veins, and are called auricles, while two of 
them send blood out to the organs and tissues of the 
body and are called ventricles. 

The right auricle receives impure blood (blood containing 
waste products) from the various organs and tissues of the 
body through the veins, which enter the heart by two main 
vessels : the Superior and Inferior Vena Cava. The impure 
blood is then pumped into the next chamber, which is the 
right ventricle. From the right ventricle it is pumped into a 
large artery, the pulmonary artery, through which it reaches 
the lungs. Here some of the waste products of the blood are 
excreted by the corpuscles. In return, the red corpuscles take 
up oxygen from the air in the lungs. 

This purified blood is now carried back along the pulmo- 

211 



212 MATERIA MEDICA 

nary veins, to the left auricle, and from there it is pumped 
into the left ventricle. The left ventricle then pumps the 
blood into the large arteries: the aorta and its branches. 
The blood then passes through these arteries and their 
branches, to the various organs and tissues of the body, 
supplying them with oxygen and nourishment. In return 
it takes av/ay the waste products from these tissues and 
organs. It then brings these waste products back to the 
heart, and thence to the lungs, where they are excreted, 
and nevf oxygen obtained instead. 

The passage of the blood, to the various parts of the body from 
the heart along the arteries, and then back again to the heart 
along the veins, is called the circulation of the blood . 

The blood is kept circulating by the regular rhythmic con- 
tractions of the heart, which in normal healthy individuals, 
occur about 72 times a minute. 

Each contraction consists of two parts or phases : 

1. The period of contraction, which is the time when the 
heart becomes smaller and expels its contents, the blood. 
This is called the systole of the heart. 

2. The period of relaxation, or period of rest, which is the 
time when the heart becomes larger, and contains a greater 
amount of blood. This is called the diastole of the heart. 

Physiology of the Heart Muscle 

It is now generally believed that the heart contracts be- 
cause of characteristic intrinsic properties of heart muscle. 
These properties are independent of the impulses which 
reach the heart through its nerves. This may be proved by 
the fact (among others) that the hearts of some animals will 
contract for a short time when the nerves are severed from 
the heart; in fact even when the heart is removed from the 
body. Physiologists have therefore studied the nature of the 
contractions of the heart and have brought to light the fol- 
lowing facts: 

(1) Heart muscle, like other muscles has the following 
properties : irritability, tone and contractility. 



CIRCULATORY STIMULANTS 213 

Irritability is the property whereby muscles are constantly 
ready to respond to a stimulus. 

Tone is the property whereby muscles maintain a state of 
constant mild contraction. 

Contractility is the property whereby muscles are able to 
contract, that is, to become shorter and thicker. The heart 
muscle differs from other muscles, however, in its contrac- 
tility. Whenever it contracts at all, it always contracts to 
the greatest degree. 

(2) Living normal heart muscle always contracts rhyth- 
mically. 

(3) The auricles and ventricles of the heart are both 
capable of contracting independently of one another. When 
they do so, the auricles and ventricles beat at different rates. 
The auricles then beat about three times as fast as the ven- 
tricles, whose intrinsic rate is about forty to the minute. 

(4) Contractions of the auricles are transmitted to the 
ventricles along a bundle of muscle fibers, which runs in the 
septum of the heart, from the auricles to the ventricles and is 
called the auriculo-ventricular bundle, or bundle of His. 

(5) The wave of contraction of the heart begins at a point 
in the right auricle where it is joined by the great veins 
(Superior and Inferior Vena Cava). This spot is called the 
sinus node. It is the most irritable part of the heart and is 
frequently called the pace maker of the heart because it 
starts the contraction. 

Method of Contraction 

(1) The stimulus at the sinus node starts the contraction 
of the auricles. This contraction wave is then transmitted to 
the ventricles by the auriculo-ventricular bundle. Ven- 
tricular contractions then follow about a fifth of a second 
later. These ventricular contractions pump blood into the 
arteries and give the pulse its rate. 

These rhythmic contractions occur about 72 times to the 
minute in the following order: 

Contraction of Sinus Node 
Contraction of Auricle 
Contraction of Ventricle 



214 



MATERIA MEDICA 



Each contraction is followed immediately by its period of 
relaxation or diastole. 



Vagus or Inhibitory Nerves 
(Impulses make heart beat 
slower) 



Superior Vena Cava . . 



Inferior Vena 
Cava 



Tricuspid 
Valve 



Opening of Pul-, 
monary Artery 
with Semilunar 
Valves. 



I I 



Sinus Node 



Accelerator Nerves 
(Impulses make heart 
beat faster) 




Pulmo- 
nary 
Veins 



Mitral 
Valve 



- - Opening of 
Aorta with Semi- 
lunar Valves 



Auriculo-Ventricular 
Bundle 

(conducts contractions 
of auricles to ven- 
tricles) 



Diagram of the heart showing the position of the auriculo-ventricular 
bundle, and the nerves. 



Heart Block 

When the auricular contractions fail to reach the ventricles, 
because the passage of contraction waves along the auriculo- 
ventricular bundle is interfered with, the condition is called 
heart block. The auricles and ventricles then beat inde- 
pendently of one another but each at its own intrinsic 
rate; the ventricles beating much slower than the auricles, 
usually about 30 or 40 times a minute. Since the ventricular 



CIRCULATORY STIMULANTS 215 

beats cause the pulse, the patient will have a pulse of 30 
or 40. 

Heart block frequently results in various diseased condi- 
tions of the heart. It can also be produced by digitalis and 
by mechanical measures in laboratory experiments. 

Partial Heart Block 

When some of the auricular contractions do reach the 
ventricles, the condition is known as partial heart block. 

Fibrillation 

When the heart muscle becomes excessively irritable, all 
its bundles of fibers do not beat in harmony and its rhythm is 
therefore disturbed. This condition is known as fibrillation. 
It is usually due to increased irritability of the heart as a re- 
sult of disease or other conditions. Auricular fibrillation is a 
condition in which groups of muscle fibers in the auricles 
beat by themselves and thus disturb the rhythm of the heart. 
Ventricular fibrillation is a condition in which bundles of 
muscle fibers of the ventricles beat independently, thus dis- 
turbing the rhythm of the ventricles. This condition is usu- 
ally fatal. 

Factors which Modify the Contractions of the Heart 

The contractions of the heart can be affected by the 
following influences: 

1. By impulses coming from the medulla of the brain 
through the sympathetic system, along special. nerves going 
to the heart called the accelerator nerves. The impulses 
transmitted by these nerves, cause the heart to beat stronger 
and faster. As a result, the contractions or systoles are 
stronger, and more frequent ; while the relaxation or diastoles 
of the heart are diminished. 

2. By impulses coming from the medulla of the brain 
along special nerves going to the heart called the Vagus, 
Pneumogastric or inhibitory nerves. These impulses make 
the heart beat slower and weaker. As a result, the relaxation 



216 MATERIA MEDICA 

periods or diastoles, are greater and more prolonged. The 
contractions or systoles, therefore, occur less frequently 
because the periods of relaxation of the heart, or diastoles, 
take up so much time. 

3. The width of the blood vessels, especially of the very 
small arteries, also influences the contractions of the heart. 

\\'Tien the blood vessels are contracted, the heart must beat 
stronger; because the narrow blood vessels offer a greater 
resistance to the contractions of the heart. 

A^Tien the blood vessels are dilated, the heart does not have 
to contract so forcibly to propel the blood through the wid- 
ened blood vessels, because they offer little resistance to 
the flow of blood. 

The width of the blood vessels is regulated by small mus- 
cle fibers in their walls. The contractions of these muscle 
fibers make the blood vessels narrower. By the relaxation 
of these muscles, the blood vessels become wider. 

Impulses are constantly being sent from a spot of gray 
matter in the medulla of the brain (the vaso motor center), 
which cause these muscle fibers to either contract or relax, 
and thereby regulate the size of the blood vessels. 

Effects of Drugs on the Heart 

Drugs affect the heart in two ways : 

1. They increase its activity (stimulation). 

2. They diminish its activity (depression). 

Stimulation of the Heart 

When drugs increase the activity, or stimulate the heart, 
they make it beat stronger and faster. The contractions or 
systoles of the heart are stronger, while the period of relaxa- 
tion or diastoles are lessened. The pulse is therefore usually 
stronger and more rapid, because the character of the pulse 
depends largely on the contractions of the heart. Practically, 
however, most heart stimulants also act upon the heart to 
make it beat slower. This is a beneficial effect; as it prevents 
the heart from becoming exhausted. 



CIRCULATORY STIMULANTS 217 

Methods of Heart Stimulation 

The increased activity of the heart is produced in several 
ways: 

a. By acting directly on the heart muscle to make it con- 
tract more forcibly, more frequently and more rhythmically. 
This may be due to increasing the tone, the irritability and 
the contractility of the heart muscle or all three. 

b. By causing more impulses to be sent along the acceler- 
ator nerves, thus making the heart beat stronger and faster. 

c. By paralyzing the nerve endings in the heart of the 
Vagus or inhibitory nerves, so that all impulses for slowing 
the heart do not reach the heart muscle. The heart then beats 
stronger and faster; the systoles or contractions are increased, 
while the diastoles or periods of relaxation are diminished. 

d. By improving the circulation within the heart muscle 
itself, thus improving its nourishment so that it is enabled 
to contract better. 

e. By contracting the small muscle fibers in the walls of 
the small blood vessels. The contractions of the heart are 
thus increased so as to overcome the greater resistance offered 
by the narrower blood vessels. The contraction of the smaU 
blood vessels always increases the blood pressure, and a rise 
in blood pressure always causes a reflex slowing of the heart. 

Many drugs increase the heart action in one or a number 
of these ways. 

Depression of the Heart 

When drugs lessen the activity of the heart (depression), the 
heart beats slower and weaker. The contractions or systoles 
are lessened, while the periods of relaxation or diastoles, 
are increased. The heart therefore beats slower and weaker 
causing a slow and weak pulse. 

Methods of Heart Depression 

Depression of the heart is produced in several ways : 
a. By directly affecting the heart muscle so that the hea^rt 
beats slower and the contractions are weaker. This may be 
due to lessening the irritability, the tone or contractihty of 
the heart muscle or all three. 



218 MATERIA MEDICA 

b. By sending impulses from the medulla of the brain 
along the Vagus or inhibitory nerves to cause the heart to 
beat slower and weaker. This effect can also be produced 
by increasing the action of the nerve endings of the Vagus 
nerve in the heart; which then become more susceptible to 
receive such impulses. 

c. By paralyzing the nerve endings in the heart of the 
accelerator nerves. The impulses for increasing the heart 
action are thus eliminated; and the heart beats slower and 
weaker. 

d. By causing the small muscle fibers in the walls of the 
blood vessels to relax, thereby widening these vessels. The 
heart then contracts less vigorously but more rapidly be- 
cause of a lessened resistance. 

Practically, however, a drug usually affects the heart in 
several ways. It may frequently stimulate certain parts of 
the mechanism of the heart while depressing others. 

Effects of Overdoses 

In overdoses, the effects of a heart stimulant or of a de- 
pressant may be the same. For example, when the heart 
action is increased, the heart beats strong and fast, but when 
it is overacting and is exhausted, the beats become slow and 
weak. In poisonous doses then, a heart stimulant may cause 
symptoms of depression. 

A drug which lessens heart action, however, or a heart de- 
pressant, always makes the heart beat slow and weak. In 
overdoses, such a substance makes the heart beat even slower 
and still weaker. 

HEART STIMULANTS 

DIGITALIS GROUP 

The drugs in the following group, have practically the 
same action with slight variations : 

Digitalis Purpurea, Purple Foxglove 
Strophantus Hispidus or Kombe, Strophantus 
Scilla Maritima, Squills 

The most efficient member of the group is digitalis. 



CIRCULATORY STIMULANTS 219 

The following drugs are less frequently used: 

Convallaria Majalis, Lily of the valley 
Helleborus Niger, Christmas rose 
Apocynum Canabinum, Canadian hemp 
Adonis Vernalis, Pheasant's eye 
Antiaris, Upas tree 
Nerium, Oleander 

and a number of others. 

Some of these drugs, for example strophantus, were used 
by the natives of Africa and in other Eastern countries as 
arrow poisons. Others were known for a long time before 
they were ever used in medicine. 

DIGITALIS 

Digitahs is a drug obtained from the leaves of the Digi- 
talis purpurea, or Purple foxglove, which grows in most 
temperate climates. The Enghsh leaves are the best. 

The leaves of the second year's growth are mostly used in 
making digitalis preparations, because they contain the 
largest amount of the active principles. 

The active principles of Digitalis are the following three 
glucosides : 

Digitoxin 
Digitalin 
Digitalein 

Digitoxin is the most potent of all, and is largely responsible 
for the digitalis effects. 

Digitalis also contains a saponin, digitonin, which is in- 
artive, however, except that it nriay occasionally be respon- 
sible for the nausea and vomiting. 

The presence of digitonin in the leaves enables the active 
principles to be dissolved in water and to prepare there- 
fore such a preparation as the infusion. In alcohol, how- 
ever, all the glucosides except the digitalein and the digi- 
tonin dissolve very readily. The Tincture of Digitalis 
therefore represents the activity of the drug devoid of the 
undesirable digitonin; besides, it keeps for a long time. 



220 MATERIA MEDICA 

ACTION 

Local Action: When injected hypodermically, digitalis is 
injurious to the tissues. It often causes inflammation and 
occasionally an abscess. 

On mucous membranes: It causes pain, redness, profuse 
secretion of mucus, and often inflammation. 

Internal Action 

In the mouth : Digitalis has a bitter and unpleasant taste. 

In the stomach: Many of the preparations of digitahs 
cause nausea and vomiting. This is due to action on the 
vomiting center, since it usually occurs after the drug is 
absorbed. 

In the intestines: Digitalis occasionally causes diarrhoea, 
because of the irritation of the lining membrane of the in- 
testines. 

Action after Absorption 

Digitalis preparations are very slowly absorbed into the 
blood from the intestines. It usually takes about 12 to 36 
hours for the effects of the drug to develop. If given hy- 
podermic ally, it enters the blood sooner, and the effects 
appear more rapidly. 

Since digitalis is so slowly absorbed, it produces pro- 
longed effects. It is therefore the best drug to give to a 
patient suffering from chronic weakened heart action (myo- 
cardial insufficiency). 

After absorption, digitahs affects principally the heart, 
the medulla of the brain and the kidneys. 

Action on the Heart: Digitalis makes the heart beat slower 
and stronger, consequently the pulse becomes slower and 
stronger. 

This is the result of the following four effects on the heart : 

(i) It makes the heart muscle contract more forcibly and 

more rhythmically, by increasing its contractile power and 

tone (see page 207). As a result the heart contracts more 



CIRCULATORY STIMULANTS 221 

forcibly and expels its contents completely. With each con- 
traction or systole a greater quantity of blood is pumped from 
the auricles into the ventricles and thence into the arteries. 

(2) It sends more impulses from the medulla of the brain 
along the Vagus or inhibitory nerves to make the heart beat 
slower, thereby prolonging the periods of relaxation or dias- 
toles of the auricles and ventricles. 

(3) It causes the auriculo-ventricular bundle to conduct 
fewer contraction waves from the auricles to the ventricles, 
thus producing a partial heart block (see page 214). In 
addition to the action on the Vagus nerve this also tends to 
slow the rate of the ventricles and to prolong their diastoles. 

(4) It improves the circulation of blood within the heart 
muscle itself, supplying it with more and better nourishment 
and thus strengthening its contractions. 

This improved circulation is brought about by the more 
forcible contractions, and by the prolonged periods of rest 
which follow. The more forcible contractions squeeze all 
the blood out of the heart muscle itself, and the subsequent 
prolonged rest permits a thorough circulation of the blood 
through the heart muscle. With each diastole (during which 
the blood circulates within the heart muscle), the heart is 
therefore refreshed with pure oxygenated, more freely cir- 
culating blood. 

The total result of these influences is to induce slow regular 
rhythmic contractions of the heart which cause a regular slow 
strong pulse. 

Effect on the Circulation 

With each prolonged period of rest or diastole the heart 
fills up with larger quantity of blood. With each succeeding 
contraction or systole a large quantity of blood is pumped 
into the arteries and is kept circulating more freely. The 
blood itself is of better quality because the improved circula- 
tion in the lungs enables the red blood cells to take up more 
oxygen. 

Secondary Effects 

As a result of the improved circulation, the various organs 
and tissues of the body are constantly receiving more and 



222 MATERIA MEDICA 

better blood which improves their nourishment and enables 
them to perform their work better. Stagnation of blood in 
these organs is relieved. Accumulated fluid in the tissues 
(oedema) is gradually removed. 

The slow rate at which the improved action of the heart 
and circulation (including the circulation within the heart 
itself) occurs, prevents exhaustion of the heart muscle from 
overactivity. It also allows the heart to recuperate from the 
effects of deleterious influences, be they the poisons of dis- 
ease or unfavorable social conditions that were responsible 
for the disturbance of an already diseased heart and poor cir- 
culation. 

The effect of digitalis on the heart may be compared to 
a driver driving a lagging horse. The lagging horse is the 
weakened heart, which is not doing enough work. The 
driver is the digitalis. 

The driver whips the horse to make him go faster and more 
energetically; but lest the horse overwork himself by going 
too fast, the driver keeps hun in check by pulling in the 
reins. The horse then works energetically, though not fast 
enough to exert himself. 

After digitalis, the heart works enei'getically; but lest 
it be overworked, it is checked by the slowing impulses 
of the Vagus or inhibitory nerves and by the lessened con- 
ductivity of the auric ulo ventricular bundle, which prevent 
it from becoming exhausted. 

Action on the blood vessels; The doses of digitahs usually 
given to patients have no appreciable effect on the blood 
vessels. In laboratory experiments, however, the blood 
vessels are made narrower by the contraction of their muscle 
fibres. 

Effect on blood pressure : The blood pressure (the pressure 
under which blood flows in the vessels) may not be affected at 
all by digitalis. Frequently, however, the blood pressure 
may be either raised or lowered, according to whether it 
was low or high as a result of the circulatory disturbance 
of the patient. 

Action on the brain : Digitalis affects only the medulla of 
the brain, especially that part of its gray matter which 



CIRCULATORY STIMULANTS 223 

sends out impulses to slow the heart (vagus center). In 
overdoses, it also sends out impulses for vomiting; and in 
such doses the impulses for motion may be increased so 
much that convulsions may result. 

Action on the kidney: Digitalis increases the flow of urine 
very markedly; especially in cases where the tissues con- 
tain a great deal of fluid (oedema) . 

The increased secretion of urine is caused in two ways: 

a. By removing fluid from the tissues : The freely moving 
current of blood prevents its stagnation in the veins and 
capillaries. The excessive fluid in the tissues then passes 
into these vessels (is absorbed). The quantity of fluid in 
the blood is thus increased and the excess is eliminated by 
the kidney, increasing the quantity of urine. 

b. By improving the circulation in the kidney: Since the 
current of blood in the kidneys flows more vigorously, more 
fluid is brought, and oftener, for the kidney to excrete. 

Poisonous Effects 

Since digitalis is slowly absorbed, and excreted still more 
slowly, it does not cause acute poisonous symptoms. 

Cumulative Digitalis Poisoning 

Cumulative digitalis poisoning frequently results from its 
continued administration. Whenever it is necessary to 
administer digitalis for a long time cumulative symptoms 
may be avoided by gradually reducing the frequency of the 
administration or by discontinuing the drug entirely, at 
intervals. 

Symptoms 

1. Persistent nausea and vomiting 

2. Diarrhoea 

3. Slow pulse; below 60, which may be irregular 

This is the most important symptom of digitalis poisoning 
and should always be reported to the physician. It means 
that a condition of heart block has been produced. 

In severe cases, or from an overdose given intravenously, 
in addition to the sudden onset of the foregoing symptoms 



224 MATERIA MEDICA 

there may be weakness, headache, disturbance of vision and 
dizziness. On the shghtest exertion the pulse may become 
very rapid (130-150), weak and irregular, the breathing 
becomes slow and deep and the urine may be scanty. 

' Treatment 

1. Stop the digitalis as soon as the pulse gets below 60 and 
is irregular. This is usually sufficient in most cases. 

2. Keep the patient absolutely quiet. 

3. Apply an ice bag or a hot water bag to the region of the 
heart. 

4. Atropine and morphine are the drugs usually given to 
relieve the condition. 

Administration 

For rapid effect, as in collapse, only some of the newer 
unofficial preparations are given. They act more quickly 
than other preparations and can be given hypodermically. 

All preparations of digitalis should be given in a wine- 
glassful of water shghtly flavored. They should always be 
given between meals when the stomach contains little acid. 
The presence of large quantities of acid in the stomach les- 
sens the absorption of digitalis preparations. 

Digitahs preparations should be fresh and made from 
reliable Enghsh leaves. The failure to obtain results from 
digitahs is often due to unreliable preparations. 

COMMON DISEASES OF THE HEART 

The following are the more common conditions in which 
digitalis is generally used : 

Myocardial Insufficiency is the only condition in which 
the nurse may observe striking effects from the use of digi- 
tahs. In the other conditions only its characteristic effect 
on the pulse may be observed. 

Myocardial Insufficiency 

(Failing Compensation or Weakened Heart Action) 

The contractions of the heart keep the blood circulating 
through the blood vessels, so that the tissues and organs of 



CIRCULATORY STIMULANTS 225 

the body may be supplied with nourishment and oxygen, 
and their waste products removed. 

When disease affects the valves of the heart, the valve 
openings become narrower (stenosis), or the valves do not 
close completely and leak (regurgitation) . The heart over- 
comes the resulting disturbed flow of blood in its cavities, 
by thickening its wall. The heart is then able to contract 
with greater force which overcomes the leaking or narrow 
valves, and it is then said to be compensated. 

When, however, the heart muscle is weak, or when there is 
auricular fibrillation so that the rhythm is disturbed, the 
blood cannot be moved along the blood vessels fast enough. 
Some of the blood then accumulates in the veins of the 
lungs, of the extremities, and of the abdomen. 

When the blood accumulates in the blood vessels of the 
lungs, the air sacs become narrower. To obtain the neces- 
sary amount of air in his lungs, the patient therefore has to 
breathe faster and deeper. The blood corpuscles cannot take 
up enough oxygen, and the blood becomes darker in color 
which causes the skin of the face and hands to become blue. 

Some of the blood also accumulates in the veins and 
capillaries of the extremities. Part of the serum of this 
accumulated blood, oozes through the walls of the vessels 
into the surrounding tissues. The tissues, particularly of 
the lower extremities, then become full of fluid (oedema). 

In the abdomen too, the accumulation of the blood, in 
the blood vessels of the stomach and intestines, results in 
congestion and oedema of the stomach and intestines. This 
causes nausea, vomiting and diarrhoea. 

The accumulation of the blood in the kidneys, results 
in lessened secretion of urine, because the kidneys are not 
supplied with sufficient fresh blood from which to excrete 
urine. 

Often the serum oozes through the walls of the blood 
vessels into the abdomen, filling it up with fluid (ascites). 

As a result of this weakened heart action or fibrillation of 
the auricles, patients present the following picture : 

At first they are very short of breath and the face is blue 
(cyanosed). Later the extremities are swollen (oedema), and 



226 MATERIA MEDICA 

in some cases, the patients have nausea, vomiting and even 
diarrhoea. The pulse is rapid, often irregular and weak. 

Appearance of the Patient after Digitalis 
When digitalis is given to patients suffering from failing 
compensation or myocardial insufficiency, all the symptoms 
disappear. Within a few days after its administration is 
begun, the patient breathes easier and the blue color of the 
skin disappears. The swelling of the extremities (oedema) 
gradually becomes lessened until it completely disappears. 
The pulse is stronger and slower. More urine is passed and 
the nausea and vomiting disappear. 

Acute Myocardial Insufficiency 
(Sudden Weakened Heart Action) 
This condition frequently results from shock, following 
operations or from collapse from any cause. As a result 
the tone and contractile power of the heart muscle is les- 
sened. The condition is characterized by a weak, regular, 
either rapid or slow pulse. The administration of hypoder- 
mic preparations of digitalis usually produces the character- 
istic slow and strong pulse. 

Auricular Fibrillation 
(See page 215.) This condition is of common occurrence 
but can be recognized only by elaborate apparatus. With- 
out such apparatus its presence may only be suspected by 
the rapid and irregular pulse. It is frequently the cause of 
the weakened heart action which produces the symptoms 
of ^^ failing compensation" in conditions of diseased valves 
of the heart. Digitalis usually relieves the condition by 
regulating the rhythm of the heart and producing a beneficial 
''heart block" with its characteristic slow strong pulse. 

Heart Block 
(See page 214.) This condition is the result of disease of 
the heart in which the auriculo-ventricular bundle is affected. 
It is characterized by a very slow pulse with periodic fainting 
spells. It is only recognized with certainty by the use of 
very elaborate apparatus. Digitalis should never be given 



CIRCULATORY STIMULANTS 227 

to such patients as it only tends to aggravate the con* 
dition. 

Preparations 
Solid Preparations 

Digitalis (Powdered leaves) 0.03-0.1 gm. grs. ^-ii 

(Digitalis) 

Extract of Digitalis 0.0075-0.03 gm. grs. f-J 

(Extractum Digitalis) 

Fluid Preparations 

Infusion of Digitalis 4.0-16.0 c.c. 5i-5i 

(Infusum Digitalis) 

The usual official infusion is a 1.5% solution, or one part 
of digitalis to 661 parts of water. 

Many physicians order weaker infusions; such as 1-150 
etc. The dose for such infusions is correspondingly greater. 

Fluidextract of Digitalis 0.06-0.12 c.c. m. i -ii 

(Fluidextractum Digitalis) 

Tincture of Digitalis 0.3 -1.0 c.c. m. v-xv 

(Tinctura Digitalis) 

This preparation keeps well and is perhaps the most 
reliable one. 

New and Non-official Preparations 

Many of the following preparations are used extensively 
and are very rehable. Some of them can be given hypo- 
dermically, because they produce effects rapidly. 

Digalen 

(Liquor Digitoxin Solubilis) 0.6-2.0 c.c. m. x-xxx 

Digalen is a solution containing digitoxin, the most ac- 
tive glucoside of digitalis, dissolved in a mixture of distilled 
water, glycerin and a very small amount of alcohol. It is 
given hypodermically, and produces its effects in from one 
to two hours. 



( r-i 



228 MATERIA MEDICA 

It is also given intravenously in doses of 0.3-1.0 c.c, 
(m. v-xv) producing effects in from 15 minutes to a half hour. 

Digalen Tablets: Each tablet contains the same amount 
of digitoxin that is contained in 0.5 c.c. (m. viii) of digalen. 

Digipuratum or Digitan 0.1 gm. gr. i^ 

These are tablets made from specially grown digitalis 
leaves from which many of the inactive substances have 
been removed. It is not so apt to cause nausea and vomiting. 
Each dose contains enough digitoxin to kill a frog weighing 
30.0 gms. by stopping its heart beat. The tablets are given 
four times a day, and reducing one tablet a day until ten 
are taken, then they are stopped. This allows the patient 
to eliminate the accumulated drug, thus avoiding cumulative 
effects. 

Digipuratum also comes in ampoules for hypodermic use, 
each containing 1.0 c.c, equivalent to 0.1 gm. (gr. 1|) of 
digipuratum. 
Digitoxin 0.00025 gm. gr. ^^ 

This is not often used, as it cannot be dissolved easily. 
Digifolin 0.3-1.0 c.c. mv-xv 

This is a soluble preparation of digitoxin. It comes in 
glass ampoules each containing 1.0 c.c. and is used hypo- 
dermically or intravenously. 
Digipoten (tablets) 0.3-1.0 c.c. m. v-xv 

This is a mixture of the digitalis glucosides in soluble form. 
Digitol 0.3-1.0 c.c. m.v-xv 

This is a fat free tincture of digitalis of the same strength 
as the ordinary tincture. It also comes in air tight ampoules 
each containing 30.0 c.c. 

There are several preparations of digit alius. They are 
not used very much because their action is unreHable. 
Many of them are made from the digitalis seeds, and con- 
tain very few active principles. 

STROPHANTUS (STROPHANTUS) 

Strophantus is a drug obtained from the ripe seeds of the 
Strophantus hispidus, a climbing shrub of Africa. It has 
been used for a long time by the natives of that country, as 



CIRCULATORY STIMULANTS 229 

an arrow poison under various names; such as kombe, inee, 
ouaye, or pahouius poison. Its active principle is a glucoside, 
strophanti!!. 

ACTION 

Strophantus acts hke digitahs but its effects vary in the 
following instances : 

1 . When given by mouth it may not be absorbed ; therefore 
its effects are unrehable. 

2. It increases the contraction of heart muscle more than 
digitalis does. 

3. It is much more poisonous than digitalis; the poisonous 
effects appear more suddenly and are more severe. 

4. It frequently causes profuse diarrhoea. 

5. It is more rapidly eliminated than digitahs. 

Its active principles, however, are very useful for in- 
travenous use. 

Preparations 

Tincture of Strophantus 0o3-1.0c.c. m. v-xv 

(Tinctura Strophanti) 

Strophantin (K) 0.0003-0.001 gm. gr. ^J^-bV 

(The active glucoside) 

This is not very rehable, since its composition varies. It 
must be freshly prepared. 

Ouabain 

(Crystallized Strophantin) 0.003-0.025 gm. gr. i^-i 

(Unofficial) 

This is given intravenously and intramuscularly, well 
diluted in doses of gr. i| o • It is obtained from a species of , 
Strophantus and is more active than the ordinary strophan- 
tin. 

SQUILLS (SCILLA) 

Squills is obtained from the bulb of the Unginea maritima 
or Squills maritima, the sea onion, a plant growing in the 
southern part of Europe. The outer coat of the bulb is 



230 MATERIA MEDICA 

removed, and the bulb is then cut into slices. From these 
slices the preparations are made. The active principle is a 
glucoside, scillain. 

ACTION 

Squills acts like digitahs but it is not as reliable. It is 
more rapidly absorbed, however, and after absorption it 
especially increases the secretions of all mucous membranes. 
It is therefore frequently used to loosen and increase the 
cough, especially in old people. In such patients the mild 
improvement of the heart action and the increased secretion 
of the kidneys benefit the general health as well. 

Preparations 
Syrup of Squills 2.0-4.0 c.c. 5H 

(Syrupus Scillae) 

Compound Syrup of Squills 0.6-2.0 c.c. m. x-xxx" 

(Syrupus Scillae Compositus) 
This contains squills, senega and tartar emetic. 

Guy's or Fothergill's Pill 

This contains calomel, squills, digitahs (powdered leaves) ; 
of each 0.06 gm. (gr. i). It is an excellent diuretic. Squills 
is usually given in pill form for diuretic action. As an ex- 
pectorant the syrup is usually given. It is also contained 
in Stokes' expectorant. 

CONVALLARIA (LILY OF THE VALLEY) 

Convallaria is obtained from the roots and underground 
stems of convallaria majalis or lily of the valley. Its active 
principle is a glucoside, convallamarin. It also contains 
a saponin, convallarin. 

Convallaria acts like digitalis, but is not as reliable. It 
is more poisonous than digitalis, however. 

Preparations 
Fluidextract of Convallaria 0.3-1.0 c.c. m. v-xv 

(Fluidextractum Convallariae) 

APOCYNUM (CANADIAN HEMP) 

Apocynum. is obtained from the root of the Apocynum 



CIRCULATORY STIMULANTS 231 

eannabinum, Canadian hemp or milkweed. Its active prin- 
ciple is apocynein, a glucoside. It acts like digitalis but is 
unreliable and very expensive. It makes the heart beat 
slower and stronger and increases the secretion of the urine. 
It is not so apt to cause cumulative symptoms. 

Preparations 

Fluidextract of Apocynum 0.3-2.0 c.c. m. v-xxx 

(Fluidextractum Apocyni) 

ADONIS VERNALIS (not official) 

Adonis vernalis is the root of the Adonis vernalis, a plant 
of northern Europe and Asia. Its active principle is a 
glucoside^ adonidin. 

It acts like digitalis but is unreliable. 

CAMPHOR (CAMPHORA) 

Camphor is obtained from the Laurus camphora or Cinna- 
momum camphora, an evergreen tree growing in China and Ja- 
pan It has been used by the Chinese for many centuries. 

It is made by chopping up the root, stems and branches 
of the tree into fine pieces and boiling them in water. The 
volatile oil which the plant contains then rises to the top. 
When the fluid is allowed to cool, part of the oil evaporates 
and leaves a thick film, which is the camphor. This is then 
skimmed off, purified and used as a drug. The sediment 
which remains when a volatile oil evaporates is called a 
stearoptene. 

Menthol is a similar stearoptene used in medicine. It is 
obtained from the oil of peppermint. 

Thujon is another similar substance obtained from the oil 
of wormwood. It therefore occurs in absinthe, and causes 
the convulsions of chronic absinthe drinkers. 

Appearance of the Patient 

About a half to one hour after an ordinary dose of cam- 
phor is given, the patient becomes calm and quiet, though 
somewhat exhilarated. He has a feeling of warmth in the 
stomach. The pulse may be stronger, but the rate may 



232 " ~ MATERIA MEDIC A 

be slow or fast and the patient breathes faster and easier. 
^Vhen it is given hypodermically, these effects appear sooner. 

ACTION 

Local action: Applied to the skin, camphor causes red- 
ness and a feeling of warmth. It reheves pain at the spot 
where it is apphed, and is slightly antiseptic. 

On mucous membranes : It causes shght contraction and is 
antiseptic. 

Internal Action 

In the mouth: Camphor has a hot, bitter taste. 

In the stomach : It causes a feeling of warmth, checks the 
formation, and hastens the expulsion of gas (carminative 
action). 

In the intestines : It often checks diarrhoea and aids in the 
expulsion of gas. 

Action after Absorption 

Camphor is absorbed from the stomach in a few hours. 
After absorption it affects principally the heart, the respira- 
tion, the brain and the secretions. 

Action on the heart: Camphor may make the heart beat 
stronger. The rate m_ay be faster or slower. Frequently 
camphor has no effect on the heart at all. 

The blood vessels are widened, however, and the pulse 
may have a bounding quahty and be either slow or fast. 

Action on the respiration: Camphor makes the patient 
breathe faster and deeper. This action is not always marked. 

Action on the brain: In the doses that camphor is usually 
given, it makes the patient feel calm and quiet, though some- 
what exhilarated. This is due to increasing the controlhng 
or inhibitory influences over the impulses usually sent out 
from the brain. In larger doses the action of the brain is 
increased. The patient then becomes more active and more 
talkative. 

In poisonous doses, the action of the entire brain is in- 
creased, the brain sending out so many impulses, for motion, 
speech, etc., that convulsions and delirium may occiir. 



CIRCULATORY STIMULANTS 233 

Action on secretions : Camphor slightly increases the secre- 
tions, especially the sweat and mucus. 

Excretion 

Part of the camphor is used up by the tissues of the body. 
The rest is eliminated in a few hours by the kidneys, sweat 
and foeces. 

Poisonous Effects 

Overdoses of camphor produce the following symptoms^ 
though they are rarely fatal: 

1. Burning pain in the stomach. 

2. Headache. 

3. Dizziness. 

4. DeHrium. 

5. Convulsions. 

6. Weakness in the extremities. 

7. Weak, small pulse, rapid or slow. 

8. Pale, cold, moist skin. 

These symptoms disappear when the drug is stopped. 

Uses 

Preparations of camphor such as the liniment, are used tc 
relieve pain, in sprains or muscular rheumatism. 

It is used as a heart stimulant, and often to lessen nerv- 
ousness. 

Recently, pneumonia has been treated by repeated intra- 
muscular injections of 10 c.c. (oiii) doses of camphor oil. 

This treatment is based upon the fact that camphor 
checks the growth of the Pneumococcus, the bacterium which 
causes pneumonia. It is then supposed to act as a specific 
in pneumonia, and at the same time to strengthen the heart 
action. 

Preparations 

Solid Preparations 
Camphor 0.1-0.6 gm. grs. ii-x 

(Camphora) 

Monobromated Camphor 0.12-1.0 gm. grs. ii-xx^ 

(Camphora Monobramata) 



234 MATERIA MEDICA 

This is occasionally used to relieve nervousness, hysteria^ 
and sexual excitement. 

Fluid Preparations 
Camphor Water 4.0-iO.O c.c. 5i-ii| 

(Aqua Camphorae) 
(Strength 1-125) 

Spirit of Camphor 0.3-2.0 c.c. m. v -xxx 

(Spiritus Camphorae) 
(Strength 10%) 

This is much stronger than the camphor water. 
Camphor Oil 0.3-0.6 c.c. m. v-x 

(Oleum Camphorae) 

This is the crude oil itself and rarely used. 

Camphor Liniment or Camphorated Oil 2.0 c.c. m. xxx 
(Linimentum Camphorae) 

This is a 20% solution of camphor in cottonseed oil 
It is used locally to relieve pain. 

It is extensively used, however, for hypodermic use as 
a heart stimulant; and in doses of 10 c.c. in the treatment 
of pneumonia. It should always be injected deeply into 
the muscles. 

Soap Liniment 
(Linimentum Saponis) 

This contains about 5% of camphor, 6% of soap, 70% of 
alcohol, and oil of rosemary. It is used locally to relieve 
pain. 

AMMONIUM 

Ammonium is a solution of ammonia gas in water. Am- 
monia is a combination of one part of nitrogen gas and three 
parts of hydrogen gas and is a strong alkali. It is formed 
when animal matter decays. 

Appearance of the Patient 

When ammonia gas is inhaled, it causes redness of the con- 
junctiva of the eye, a profuse flow of tears, a flow of mue is 



CIRCULATORY STIMULANTS 235 

from the nose, and sneezing; due to the red and swollen 
condition of the mucous membranes. 

It also causes severe coughing with excessive secretion 
of mucus from the bronchi, due to the irritation of their 
lining membrane. The pulse is stronger and faster, and the 
breathing is deeper and more rapid. 

These effects appear almost immediately, but last for 
a very short time. 

ACTION 

Xocal action : A weak solution of ammonia makes the skin 
red and soft. The skin feels slippery, as if it were covered 
with soap. Stronger solutions, if kept in contact with the 
skin and prevented from evaporating, form blisters (vesicant 
action), often destroying the skin (escharotic action). 

On mucous membranes : It causes a red and swollen condi- 
tion, with profuse secretion of mucus. The same destructive 
action as on the skin, results if it is allowed to remain in 
contact with the mucous membrane. On the conjunctiva, 
this results in a profuse flow of tears. In the nose, a profuse 
flow of mucus and sneezing. In the bronchi : When inhaled, 
or when given internally, it causes an excessive secretion of 
mucus which is somewhat more fluid in character. 



Internal Action 

In the mouth: Ajnmoma has a pungent taste, it reddens 
and sHghtly swells the Uning membrane^ and increases the 
flow of saliva. 

In the stomach: It irritates the mucous membrane and 
neutralizes the hydrochloric acid of the gastric juice, lessening 
the digestion of food. 

Action after Absorption 

When ammonia is absorbed from the hning membrane 
of the stomach, it produces no effects; because it is changed 
at once to urea, one of the constituents of the urine. It 
therefore increases the amount of urea in the urine. 



236 MATERIA MEDICA 

Anmionia is usually given by inhalation and it produces 
its best effects in this manner; they are not very lasting how- 
ever. When given by mouth, the same but more lasting 
effects are produced. The drug is absorbed from the stomach 
in the form of ammonium chloride, which is formed by the 
combination with the hydrochloric acid in the stomach. 

Ammonia affects principally the heart and the respiration. 

Action on the heart: It makes the heart beat stronger 
and faster, causing a strong and rapid pulse. 

Action on the respiration: It makes the breathing more 
rapid and deeper. 

These effects are not due to absorption of the drug, but to 
the red and swollen condition (irritation) of the mucous 
membrane of the eyes, nose and bronchi. This irritation 
affects the nerve endings in these mucous membranes, caus- 
ing them to send impulses to the medulla of the brain. The 
medulla immediately responds to these impulses by sending 
impulses to make the heart beat stronger and faster, and 
to increase the depth and frequency of the breathing (reflex 
action). When given by inhalation these effects appear 
almost immediately, but last for a very short tnne. 

When given by the mouth, the same but more lasting 
effects are produced, in a similar manner. They are due 
to the reflex action resulting from the irritation of the mu- 
cous membrane of the stomach. 

Excretion 

Ammonia is excreted as urea, a normal ingredient of the 
urine. The urine therefore contains a larger amount of 
urea. Ammonia is also excreted by the resulting profuse 
secretion of the mucous membrane of the bronchi. 

Poisonous Effects 
Acute Ammonia Poisoning 

When a strong solution of ammonia is taken, the following 
symptoms result ahnost immediately: 

The patient complains of severe burning pain in the mouth- 



CIRCULATORY STIMULANTS 237 

throat and stomach. The lips, mouth, throat, oesophagus 
and larynx are inflamed and swollen. Often the superficial 
tissues of these organs are destroyed. The swelling of the 
larynx may be so severe as to obstruct the breathing and the 
patient may choke to death because he is unable to get air 
into his lungs. 

In addition to these symptoms, the patient feels nauseated, 
and vomits profusely. The vomited matter contains blood 
and pieces of the mucous membrane of the stomach. 

The continual vomiting and the destruction of the hning 
membrane of the stomach cause the symptoms of collapse : 
pale, cold moist skin; rapid, weak, thready pulse; slow, 
shallow breathing; finally stupor, coma and death. Death 
may result in a few minutes from asphyxia, or later from 
collapse. 

If the patient recovers, the resulting scars which form in 
the oesophagus from the destruction of the tissues, may 
cause stricture (a narrow condition) of the oesophagus. 

This may cause starvation from mability to swallow food. 

Treatment 

1. Neutralize the ammonia with dilute acids, that are 
not themselves injurious. Vinegar and lemon juice are the 
best acids to use. 

2. Protect the lining membrane of the oesophagus and 
stomach with milk, oils, albumin water and other protecting 
drinks. 

3. The collapse is usually treated with heart stimulants, 
such as caffeine, atropine and strychnine. 

4. Do not keep the patient warm; as heat increases the 
action of ammonia. Apply cold applications to the head and 
give plenty of cold air. 

5. If the patient suffers from asphyxia, incising the trachea 
(tracheotomy) may save the patient's life. 

6. For the resulting stenosis of the oesophagus, bougies 
are passed, or surgical interference may be necessary. 



238 MATERIA MEDICA 

Uses 
Ammonia is used for the f ollowirxg conditions : 

1. As a heart stimulant for temporary effect, for example 
in fainting. 

2. In the form of liniments, to relieve pain. 

3. To neutralize the acid of the gastric juice-. 

4. To check the formation of gas in the stomach. 

5. To increase the cough and expectoration. 

Preparations 

Fluid Preparations 
Strong Ammonia Water 
(Aqua Ammoniae Fortior) 

This contains about 28% of ammonia gas. It is never 
given internally. It is used locally, applied to snake bites 
and to form a bhster to withdraw fluid from the deeper 
tissues. 

Ammonia Water 0.6-2.0 c.c. m. x-xxx 

(Aqua Ammoniae) 

This contains 10% of ammonia gas. 

Aromatic Spirit of Ammonia 2.0-4.0 c.c. 54-i 

(Spiritus Ammoniae Aromaticus) 

This contains ammonia water and 4% of ammonium car- 
bonate, together with the oil of nutmeg, oil of lemon 
and oil of lavender. 

It is used principally to overcome fainting, as a carmina- 
tive, and to reheve nausea. 

Solution of Ammonium Acetate 4.0-16.0 c.c. 3i-iv 

(Liquor Ammonii Acetatis) 
(Spirit of Mindererus) 

This is used principally to increase sweating (diaphoretic) 
and to increase the flow of urine (diuretic). 

For Local Use 
Ammonia Liniment 
(Linimentum Ammoniae) 

This is a 3i% solution of ammonia in alcohol and cotton- 
seed oil. 



CIRCULATORY STIMULANTS '239 

Solid Preparations 

Ammonium Carbonate 0.3-0.6 gm. grs. v-x 

(Ammonii Carbonas) 

This is used as a heart stimulant and as an expectorant. 

Ammonium Chloride 0.3-1.3 gm. grs. v-xx 

(Ammonii Chloridum) 

This is used principally as an expectorant (see page 267.) 
There are numerous other salts of ammonium, such as 

ammonium bromide, ammonium iodide, etc. They are 

used principally for the effect of the bromide, iodide, etc. 

The combination with ammonium, however, may strengthen 

the heart action. 



OTHER HEART STIMULANTS 

The following drugs are used extensively as heart stimu- 
lants. Their general action will be considered later. 

ATROPINE 

Atropine makes the heart beat stronger and faster. It 
paralyzes the nerve endings in the heart, of the Vagus or 
inhibitory nerves, which carry impulses to make the heart 
beat slower. A^Tien the nerve endings of these nerves are 
paralyzed, these impulses are cut off. The heart therefore 
beats stronger and faster; consequently the pulse, after 
atropine, is stronger and faster. 

For other actions and preparations, see page 410. 

STRYCHNINE 

Strychnine makes the heart beat slower and stronger. It 
causes the medulla of the brain to send impulses along the 
Vagus or inhibitory nerves, to make the heart beat slower. 
It also contracts the blood vessels, and by thus offering 
greater resistance to the heart, makes the heart beat stronger. 
The pulse is therefore slower and stronger after strychnine. 

For other actions and preparations, see page 296. 



240 MATERIA MEDICA 

CAFFEINE 

Caffeine is used in cases of collapse to improve the char^ 
acter of the pulse and breathing. It causes an evanescent 
rapid, perhaps stronger pulse. This is the result of the action 
of caffeine on the brain and medulla. The greater number of 
impulses sent from the vaso constrictor center of the medulla 
cause slight contractions of the small muscle fibers in the 
walls of the blood vessels which make the blood vessels 
narrower and thus temporarily improve the character of 
the pulse. 

ALCOHOL 

Alcoholic liquors make the heart beat stronger and faster. 
Because the blood vessels are widened (dilated) the pulse 
has a bounding quality; since the contractions and relaxa- 
tions of the heart can be more easily transmitted along the 
wider blood vessels. 

The pulse after alcohol is therefore strong, fast and bounding. 
The effects last only for a very short time, however, and 
are the result of the local irritation of the mucous membrane 
in the mouth or at the site of injection. For hypodermic 
use, whiskey is the preparation commonly used. 

For other actions and preparations, see page 330. 

MUSK 

Musk is occasionally used as a heart stimulant. It is 
very expensive and very unreliable. When its effects are 
produced, it makes the heart beat stronger and faster. The 
pulse is therefore stronger and faster. The effects wear off 
very quickly. 

For other actions and preparations, see page 394. 

VASO CONSTRICTORS 
(Drugs which Contract the Blood Vessels) 

EPINEPHRINE (ADRENALIN) 

Epinephrine is an extract containing all the active prin- 
ciples, of the suprarenal or adrenal glands of the sheep or ox. 



CIRCULATORY STIMULANTS 241 

The adrenal gland is a small pyramidal gland situated im- 
mediately above the kidney. 

Appearance of the Patient 

After an intravenous or hypodermic injection of epine- 
phrine, the following effects are noticed within 15 or 20 
minutes after it is given : 

The skin becomes pale, all the visible mucous membranes, 
such as the lips and conjunctiva become pale and blanched. 
The pupils are dilated. There is an excessive secretion o( 
saliva and mucus in the mouth. 

The pulse is slow, strong, and tense; the blood pressure 
being greatly increased, so that it is difficult to obliterate 
the pulse by pressure with the finger. The breathing is 
somewhat deeper. These effects wear off in an hour. 

ACTION 

Local action : Applied to the skin, epinephrine has no action. 
If applied to a bleeding point, it checks the bleeding by con- 
tracting the blood vessels. On mucous membranes: It makes 
the mucous membranes pale by contraction of the underlying 
blood vessels. For example — if applied to the conjunctiva of 
the eye, epinephrine makes it pale, it widens the eyelids, 
dilates the pupils and shghtly protrudes the eyeball. In 
the nose; It makes the mucous membrane pale and con- 
tracted, and thereby widens the nasal cavities. 

Internal Action 

In the mouth: Epinephrine contracts the mucous mem- 
brane, from which it may be slightly absorbed. 

Since epinephrine is an extract of a gland (an organ of 
the body), it is digested by the gastric juice of the stomach. 
It therefore produces no general effects when given by the 
mouth. To obtain its effects, it must be given either in- 
tra venousl v. intramuscularly or hypodermically. 

Action after Absorption 
When given intravenously, the effects appear in about 



242 MATERIA MEDICA 

five to ten minutes. When given intramuscularly or hy* 
podermically, the effects appear within a half hour. 

After absorption, epinephrine affects principally the blood 
vessels, the heart, the involuntary muscles, the pupils and 
secretory glands. 

Action on the blood vessels: This is the most important 
effect of epinephrine. It makes all the small blood vessels, 
especially the small arteries, narrower by contraction of 
the small muscle fibers m their walls. The blood vessels in 
the abdomen are contracted most of all, those in the 
brain and lungs least. The coronary vessels in the heart 
are dilated, however. By the contraction of the blood 
vessels it greatly increases the blood pressure (the pressure 
of the blood in the blood vessels). It is the best drug for 
increasing the blood pressure. 

The narrower blood vessels offer a greater resistance for 
the heart, thus increasing the force of its contractions. 

The increase in blood pressure causes impulses to be sent 
to the Vagus center in the medulla, to which it responds by 
sending impulses to slow the heart (in a reflex manner). 

Action on the heart : Epinephrine makes the heart beat slower 
and stronger: 

This results from the following effects : 

1. The increased contractions of the heart muscle (in- 
creased tone and contractihty) . 

2. The contractions of the blood vessels. 

3. The increase in blood pressure which makes the heart 
beat slower. 

The total effect of epinephrine on the circulation is,. there- 
fore: 

Slow, strong contractions of the heart with greatly in- 
creased blood pressure, which make the pulse slow, strong, 
and tense. 

Action on involuntary muscles: Epinephrine increases the 
contractions of the involuntary muscles of the uterus, and 
its blood vessels. 

The involuntary muscles of the stomach and intestines are 
relaxed; though the blood vessels in their walls are con- 



CIKCULATOHY STIMULANTS 243 

tracted. Action on the Pupil: The pupil of the eye is widened 
(dilated) by contraction of the radial fibers of the iris, or 
colored part of the eye. 

Action on the secretory glands: The secretions of all the 
secretory glands, except the sweat glands and the pancreas^ 
are increased by epinephrine. This effect is produced by 
making the nerve endings in the glands more sensitive to 
stimuli. As a result of this action, they receive more im- 
pulses, which make the glands secrete more profusely. 

Epinephrine therefore increases the flow of saliva, mucus 
in the mouth, the flow of tears and bile. 

The secretion of the sweat and pancreatic juice is not in- 
creased. It often causes sugar in the urine (glycosuria). 

The effect of epinephrine wears off very quickly; usually 
in about 15 minutes to an hour. 

Excretion 

Epinephrine is mostly destroyed in the body. Part of it, 
however, is eliminated by the kidneys in about an hour or two. 

Poisonous Effects 

Overdoses of epinephrine cause the following symptoms: 

1. Slow irregular pulse. 

2. Pale, blanched skin. 

3. Dilated pupils. 

From still larger doses the following symptoms will also 
occur: 

1, Rapid, weak, thready pulse. 

2. Collapse: Pale, cold, moist skin, slow and shallow 
breathing, and dilated pupils. 

A single overdose may cause such profound collapse, 
that death may result. 

Uses 

Epinephrine is used for the following conditions: 

1. To check bleeding by contracting the bleeding vessels. 

It, is only of value in bleeding from the small blood vessels. 

The bleeding may start up again, however, when the effect 



244 MATERIA MEDICA 

of the drug wears off, because after the blood vessels are con. 
tracted; they soon dilate again. 

In bleeding from the nose, stomach, intestines, uterus or 
bladder, epinephrine is very valuable, if it can be applied 
to the bleeding spot without the necessity of an elaborate 
surgical procedure. 

2. As a heart stimulant, especially where a rapid effect 
is desired. The effect soon wears off, however. 

3. Epinephrine is often used together with cocaine. It 
contracts the blood vessels, lessening the absorption of 
the cocaine, which is then less apt to cause poisonous 
effects. 

4. In the treatment of Addison's disease (tuberculosis 
or cancer of the adrenal glands) . It then supphes the absent 
secretion of the adrenal glands. 

Preparations 

Dried Suprarenal Glands 0.25 gm. grs. iv 

(Glandulae Suprarenales Siccae) 

The powdered dried suprarenal glands of the sheep or ox. 

Epinephrine Chloride 0.3-1.0 c.c. m. v-xv 

(1-1000 solution) 
Adrenalin Chloride Solution 0.3-1.0 c.c. m. v-xv 

This is a 1-1000 solution of adrenalin chloride, the active 
principle of the suprarenal glands, in normal salt solution. 

Adrenalin Inhalant 

This is a 1-1000 solution of adrenalin chloride in oil. 
Adrenalin Ointment 

An ointment of adrenalin chloride 1-1000 in strength. 
AdrenaUn Suppositories 

A 1-1000 solution of adrenahn chloride in cocoa butter. 
Adrenalin Tablets 

Each tablet contains 0.001 gm. (gr. -zh) of adrenalin 



CIRCULATORY STIMULANTS 245 

borate. Each tablet when dissolved in 1.0 c.c. (m. xv) of 
water, makes a 1-1000 solution. 

Adrenalin is a patented name for epinephrine. There 
are other preparations of epinephrine, made by other firms 
under various names, such as: 

Adnephrin 
Suprarenalin 
Suprarenin 
Supracapsulin 

The preparations of these are the same as those of adre- 
nalin. L . Suprarenin Synthetic is an artificial preparation 
of adrenalin. 

Administration 

Epinephrine is given intravenously, intramuscularly, or 
hypodermically. When it is given intravenously, it must be 
injected very slowly, to avoid poisonous effects. 

For local effect, it is used in 1-15000 to 1-1000 solutions, 
preferably in oil. 

PITUITARY EXTRACT (PITUITRIN) 

Pituitary extract is a substance made from the posterior 
part of the pituitary gland. This is a small gland situated at 
the base of the brain. 

ACTION 

The following are the principal effects of pituitary extract; 
they are similar to those of epinephrine. 

1. Pituitary extract makes the heart beat slower and 
stronger by directly affecting the heart muscle. 

2. It makes the blood vessels narrower by contracting the 
small muscle fibers in their walls. It therefore greatly in- 
creases the blood pressure. This effect appears slowly but is 
more prolonged than that of epinephrine. The blood vessels 
of the kidney are the only ones that are dilated. 

3. It increases the contractions of the uterus. 



246 



MATERIA MEDICA 



4. It contracts all involuntary muscles. It increases 
peristalsis ; thus helping to expel gas from the intestines. 

5. It may relieve many of the symptoms due to deficient 
function of the posterior lobe of the pituitary gland in the 
brain (Hypopituitarism). (See page 548.) 

It is used principally to increase uterine contractions and 
hasten labor. It is also used as a heart stimulant to in- 
crease the blood pressure in infectious diseases such as 
pneumonia, etc., and to expel gas from the intestines. 



Pituitary Extract 
Pituitrin 



Preparations 

1.0 c.c. m. XV 

1.0 c.c. m. XV 



ERGOTOXINE 

This is the active principle of Ergot. It contracts the 
blood vessels and increases the blood pressure. 



Table of Circulatory Stimulants 



Drugs acting Drugs acting 
rapidly. Suit- i slowly. Suit- 
able for imme-;able for con- 
diate effect, tinuous effect. 


Drugs causing a Drugs causing 


Drugs whose 


Drugs which 


rapid pulse. 


a slow pulse. 


off quickly. 


pressure. 


Caffeine Digitalis 


! 
Caffeine j Digitalis 


Caffeine 


Epinephrine 


Strychnine 


Strophantus 


Atropine 


Strychnine 


Ei)inephrinc 


Pituitary 


Atropine 


Squills 


Ammonium 


Epinephrine 


Ammonium 


Extract 


Camphor 


Convallaria 


Alcohol 


Pituitary 


Alcohol 


Ergotoxine 


Epinephrine 


Apocynum 


Camphor 


Extract 


Musk 




Pituitary 


Adonis Ver- 


(sometimes) 


Camphor 






Extract 


nalis 


Musk 


(some- 






Ammonium 






times) 






Alcohol 






Strophantus 






Digalen 






Squills 






Digipuratum 






Convallaria 






(ampoules) 






Apocynum 






Musk 






Adonis Ver- 
nalis 


( 





CHAPTER XIII 

CIRCULATORY DEPRESSANTS 

The most important effect of the following group of drugs 
is to lessen the action of the heart. (See page 217 for heart 
depression.) 

ACONITE (MONK'S HOOD OR WOLFSBANE) 

Aconite is obtained from the root of Aconitum napellus, 
monk's hood or wolfsbane, a perennial plant growing in the 
mountainous regions of Europe and Asia. The root often 
resembles horse-radish in appearance. The active principle 
of aconite is the alkaloid, aconitine. There are several other 
species of aconite which contain several similar alkaloids 
such as pseudaconitine and japaconitine, which produce the 
same effects as aconitine. 

Appearance of the Patient 

When an average dose of aconite is given, the patient's 
mouth and throat feel warm, and he often complains of 
slight numbness and tingling of the lips, tongue and throat, 
or even in the extremities. The pulse is slower and some- 
what weaker, and the breathing is usually slow and shallow. 
The temperature is lowered and the patient often feels quite 
weak. 

ACTION 

Local action: Applied to the skin or mucous membranes, 

aconite or aconitine causes a prickling or tingling sensation. 
This is due to the greater sensitiveness of the nerve endings 
in the skin or mucous membranes. The ordinary sensations 
of touch are then felt as prickhng or tingling sensations. 
Soon, however, these nerve endings are paralyzed, and the 
skin or mucous membranes feel numb. Very often this 
increased sensitiveness causes various reflex actions. For 

247 



248 MATERIA MEDICA 

example — when aconite is applied to the mucous membrane 
of the nose, it causes sneezing. Increased flow of saliva, 
vomiting and coughing also often result in a reflex manner, 
from the local application of aconite to mucous membranes. 

Internal Action 

In the mouth; Aconite has a bitter taste and causes a 
prickling and tingling sensation followed by numbness in 
the mouth and throat. This effect on the nerve endings in 
the mouth, causes a reflex flow of sahva. Later the secretions 
are checked and the mouth feeh dry. 

In the stomach and intestines; In the doses that aconite 
is usually given, it produces no effect. In larger doses, how- 
ever, it often causes nausea and vomiting by the reflex con- 
tractions of the muscles of the stomach and intestines, as a 
result of the greater sensitiveness of their nerve endings. 

Action after Absorption 

Aconite is absorbed into the blood stream through the 
hning membrane of the stomach, usually in about half an 
hour after it is given. After absorption, it acts principally 
upon the heart, the respu'ation, the nerve endings and the 
temperature. 

Action on the heart; Aconite makes the heart beat slower 
and weaker, and lessens the blood pressure. The effect on 
the heart is due to the increased number of impulses which 
are sent to the heart from the cardio-inhibitory center in the 
medulla of the brain, along the Vagus or inhibitory nerves. 

The pulse of aconite is usually slow, weak, soft and compres- 
sible. 

Action on the respiration; Moderate doses of aconite in- 
crease the breathing, but large doses make the breathing 
slower and labored. 

Action on the nervous system; Aconite does not act on 
the brain, but it produces important effects as a result of 
its action on the nerve endings. 

Action on the nerve endings; When taken internally, or 
when applied locally, aconite makes the sensory nerve end- 
ings of the skin and mucous membranes more sensitive at 



CIRCULATORY DEPRESSANTS 249 

first, and later paralyzes them. This produces the tingling 
and prickling sensations, followed by numbness, which are 
so characteristic of aconite. 

The muscular weakness produced by aconite in large doses, 
is due to its effect on the nerve endings in the muscles. 

Action on the secretory glands : Aconite increases the secre- 
tion of sweat and saliva, by making the nerve endings in 
the mouth and skin more sensitive, thus reflexly increasing 
the secretions. 

Effect on temperature: It reduces temperature by in- 
creasing the elimination of heat. 

Excretion 

Aconite is eliminated from the body in about three or 
four hours after it is given, mainly by the urine. 



Poisonous Effects 

Since aconite is rapidly excreted, only acute aconite poi- 
soning occurs, usually from the administration of an over- 
dose. 

Aconite is one of the few poisons which cause death very 
rapidly. If a sufficiently large dose is taken, the patient 
may die immediately, from sudden paralysis of the heart. 
Usually, however, the symptoms appear very rapidly and 
the patient dies in about three or four hours. 



Symptoms 

The first, and diagnostic symptom of aconite poisoning 
is: 

The characteristic tingling and prickling sensation on the 
lips, mouth and throat, and a smarting, tingling feeling of the 
skin of the extremities, soon followed by numbness. Later 
this sensation passes over the entire body. 

2. Profuse flow of saliva. 

3. Nausea and vomiting. 

4. Great muscular weakness. 



250 MATERIA MEDICA 

5. Slow, irregular, weak pulse. 

6. Slow, shallow, difficult, irregular breathing. 

7. Collapse (cold, moist skin; anxious face; protruding eye- 
balls with dilated pupils; rapid, thready, very weak pulse). 

8. Often there are convulsions and unconsciousness just 
before death. Usually however, consciousness remains to 
the last. Death usually results from paralysis of the res- 
piration. 

Treatment 

To save a patient from aconite poisoning, quick action 
is necessary, as death results very rapidly. 

1. Wash out the stomach. 

2. Atropine is given as an antidote. 

This prevents the slow weak heart action, by paralyzing 
the nerve endings in the heart, of the Vagus nerve, and it 
also makes the breathing faster and deeper. 

3. Keep the patient absolutely quiet, flat on his back, 
lower the head by removing the pillows, and elevate the 
foot of the bed. 

4. Give artificial respiration. 

5. Heart stimulants such as caffeine, whiskey, ammonia, 
are usually given. 

Uses 

Aconite is now rarely used. It is principally given to 
reduce fever in acute infectious diseases. 

Preparations 

Fluidextract of Aconite 0.06 0.12 c.c. m. |^-ii 

(Fluidextractum Aconiti) 

Tincture of Aconite 0.06-0.3 c.c. m. i-v 

(Tinctura Aconiti) 
This is the preparation commonly used. 

For Local Use 

Aconite Liniment (not ofl&cial) 
(Linimentum Aconiti) 

This contains about 2% of aconite, and is an ingredient 



CIRCULATORY DEPRESSANTS 251 

of many patent medicines which are used to reheve the 
pains of chronic rheumatism. 

Aconite Ointment (not official) 
(Unguentum Aconiti) 

This contains 2% of aconite. 

Aconinite 
Aconitine 0.00015-0.0006 gm. gr. To^ik 

(Aconitina) 

STAPHISAGRIA (STAVESACRE OR DELPHINIUM) 

Staphisagria or stavesacre is obtained from the dried 
ripe seeds of Delphinium staphisagria or stavesacre. 

Its active principle is an alkaloid, delphinine, which pro- 
duces the same effects as Aconitine. 

Delphinine is used in the form of a tincture or ointment 
to destroy parasites, such as hce. 

VERATRUM (AMERICAN HELLEBORE) 

Veratrum is obtained from the root and underground 
stems of the Veratrum viride, or green hellebore, a plant 
which grows in swampy places in the northern part of the 
United States. It is commonly known as American or 
swamp hellebore, or Indian poke. There is also another 
species of veratrum known as Veratrum album, or white 
hellebore. 

The active principles of veratrum are the alkaloids, cevadine 
and veratrine. These alkaloids are very closely related to 
aconitine chemically, and they produce very similar effects. 

ACTION 

The following are the principal effects of veratrum. They 
resemble those of aconite but they differ in several instances : 

1. Locally veratrum is very irritating to the skin and 
mucous membrane but is soon followed by a local soothing 
effect. It causes profuse sneezing and coughing when in- 
haled. 



252 MATERIA MEDICA 

2. It frequently causes nausea and vomiting. 

3. It makes the heart beat slower and weaker, by increas- 
ing the impulses sent to it through the Vagus nerves, thus 
causing a slow soft pulse. 

4. It lowers the blood pressure. 

5. It slightly increases the contraction of muscles but it 
markedly prolongs the period of relaxation. This is a very 
characteristic effect of veratrum and is often spoken of as 
^'veratrine effect.'^ 

Veratrum is used principally to lower blood pressure in 
eclampsia, a condition of poisoning occuring in pregnancy. 

Preparations 

Fluidextract of Veratrum 0.06-0.3 c.c. m. i-v 

(Fluidextractum Veratri) 

Tincture of Veratrum 0.3-1.0 c.c. m. v-xv 

(Tinctura Veratri) 

VERATRINE 

Veratrine is a mixture of all the alkaloids found in Vera- 
trum sabadilla, or Asagraea officinalis, a Mexican plant 
known as cevadilla. The most important of these alkaloids 
are veratrine and cevadine, which are also found in veratrum 
viride. 

It produces the same effects as veratrum. 

It is used principally to relieve pain in neuralgia, rheuma- 
tism, etc. 

Preparations 
Veratrine Ointment 
(Unguentum Veratrinae) 

This contains 4% of veratrine. 

Oleate of Veratrine 
(Oleatum Veratrinae) 

This contains 2% of veratrine. 



CIRCULATORY DEPRESSANTS 253 

Other Heart Depressants 

The following drugs also lessen the heart action, but 
they have other more important effects under which they 
will be described. 

They cause slow, weak contractions of the heart, produc- 
ing a slow, w^eak pulse. 

Eserine or Physostigmine 

Pilocarpine 

Grindelia 

Lobelia 

Dilute Hydrocyanic Acid 

VASO-DILATORS 

(Drugs which Dilate the Blood Vessels) 

The following drugs act principally on the blood vessels. 
They lessen the contractions of the small muscle fibers in 
their walls, so that the blood vessels are widened. As a 
result of this action, various effects are produced upon vari- 
ous organs and tissues of the body. 

THE NITRITES 

The nitrites are salts formed by the combination of ni- 
trous acid with an alkali, or an organic substance such as 
an alcohol, as amylic alcohol. The most important com- 
pounds formed in this way, are amyl nitrite and nitro- 
glycerine. Amyl nitrite produces rapid effects which soon 
pass off, and nitroglycerine produces slower effects which 
are more lasting. 

AMYL NITRITE 

Amyl nitrite is a yellow fluid which evaporates easily, 
and has a characteristic odor of fruit. It is made by dis- 
tilling nitric acid with amylic alcohol, sulphuric acid and 
copper, and then purifying the resulting liquid. 

Appearance of the Patient 

About three to five minutes after an average dose of amyl 
nitrite is inhaled, the face becomes flushed, and sometimes 



254 MATERIA MEDICA 

the skin all over the body as well. The patient complains 
of fullness and throbbing in the head, and often of severe 
headache. The pulse is rapid, soft and bounding, and the 
breathing is rapid and somewhat deeper. These symptoms 
last for about ten to fifteen minutes, and then pass off. 



Administration 

Amyl nitrite is usually given by inhalation. It comes in 
small glass ^^ pearls," each containing about 0.2-0.3 c.c. 
(m. iii-v) of am.yl nitrite, which are broken in a handker- 
chief and then applied to the nose of the patient. The 
handkerchief should be withdrawn as soon as the effects 
are produced. Amyl nitrite is occasionally given hypoder- 
mically. It is also given by the mouth; about 0.2-0.3 c.c. 
(m. iii-v) dropped on a piece of sugar; but the effects then 
appear very slowly. 

Uses 

Amyl nitrite is used for the following effects : 

1. To relieve an attack of ^^ angina pectoris, '^ a disease 
characterized by attacks of severe pain around the heart, 
and shooting pains into the left arm. This disease is due to 
the spasmodic contractions of the muscle wall of the coro- 
nary arteries in the heart, (the vessels which supply the 
heart muscle with blood). Amyl nitrite reheves these at- 
tacks by relaxing the spasms of these blood vessels. 

2. To relieve an attack of bronchial asthma; by relaxing 
the spasm of the involuntary muscles in the walls of the 
bronchi. 

Preparations 

Amyl Nitrite 0.15-0.3 c.c. m. ii-v 

(Amylis Nitris) 

This comes in small glass capsules (pearls) each contain- 
ing the required dose. It should always be fresh; as it de- 
composes very easily. 



CIRCULATORY DEPRESSANTS 255 

ACTION OF THE NITRITES 

Appearance of the Patient 

The effects that result from the use of the nitrites are the 
same as those following amyl nitrite, but they appear very 
slowly. 

ACTION 

In the mouth : Nitroglycerine has a pungent taste. 
In the stomach: All the nitrites with the exception of 
nitroglycerine, may cause nausea and vomiting. 

Action after Absorption 

The nitrites are very rapidly absorbed into the blood, 
through the lining membrane of the stomach. After absorp- 
tion, they affect principally the blood vessels, the respiration 
and the kidneys. 

Action on the circulation: The nitrites do not affect the 
heart directly, but by means of their action on the blood 
vessels. 

Action on the blood vessels: The nitrites affect prin- 
cipally the blood vessels. They paralyze the small involun- 
tary muscle fibers in the walls of the small blood vessels. 
As a result, these blood vessels are widened, so that it is 
easier for the blood to pass through them, and the blood 
pressure is lessened. The heart does not then have to con- 
tract so forcibly, because the blood moves along more freely, 
and it does not need much propelling force, since the blood 
vessels are wider. The heart contracts faster, however, 
because the wider blood vessels offer very little resistance 
to the contractions of the heart, which then contracts with 
greater ease. By the action on the blood vessels, the nitrites 
ease the action of the heart, when it is overworking because 
of increased blood pressure, or because of spasmodic con- 
tractions of the blood vessels. 

The blood vessels of the abdomen and head are more 
affected than those of the extremities. 

The total effect of the nitrites on the circulation is to 



256 MATERIA MEDICA 

make the heart beat faster, and to lower the blood pressure. 

Consequently the pulse is rapid, soft and bounding. 

Action on the respiration: The nitrites make the breathing 
faster and deeper. 

Action on the nervous system: The nitrites do not affect the 
nervous system directly. The headache, the fullness in the 
head and the occasional dizziness, are due to the dilated blood 
vessels in the brain, which then contains more blood (con- 
gestion), as a result of which these sensations are produced. 

Effect on temperature: The temperature is somewhat 
lowered. 

Action on the kidneys : The flow of urine is often increased 
by the nitrites, when the kidneys do not secrete a sufficient 
amount of urine, because of the high blood pressure. The 
better circulation of blood in the kidneys as a result of the 
widened blood vessels, increases the secretion of urine. 

Excretion 
The nitrites are excreted by the urine, usually in about 
one or two hours. 

Poisonous Effects 

Poisonous symptoms usually occur suddenly from the 
inhalation of an overdose of amyl nitrite. After prolonged 
administration of the other nitrites the same symptoms occur 
but more gradually. 

Symptoms 

1. Flushing of the face and neck. 

2. Intense throbbing headache (a feeling of a tight band 
around the head or as if the ^^head were coming off). 

These symptoms frequently occur from an ordinary dose 
of amyl nitrite but soon pass off. Occasionally from a single 
dose of amyl nitrite, and from continued use of other nitrites 
the following symptoms may also occur: 

3. Faintness. 

4. Dizziness. 

5. Dilated pupils. 

6. Slow, irregular pulse. 

7. Confusion of ideas. 

8. Collapse. 



CIRCULATORY DEPRESSANTS 257 

The symptoms usually improve when the patient is lying 
down or when the drug is stopped. 

Administration 
The nitrites should be given in a wineglassful of milk 
after meals. If tablets are used these should be dissolved 
in the milk. 

Uses 

The nitrites are given principally in repeated doses for a 
long time, in the following conditions : 

1. Arteriosclerosis, or hardening of the arteries. 

It relaxes the contractions of the arteries whose muscle 
fibers have not yet been replaced by connective tissue. In 
many cases nitroglycerine produces no effect, as the muscle 
fibers have been replaced by fibrous tissue, which is not elastic. 

2. To reduce blood pressure, in nephritis. 

3. To relax the contractions of the involuntary muscles 
in the bronchi, in asthma. 

4. To prevent the attacks of angina pectoris by keeping the 
muscles of the coronary blood vessels of the heart relaxed. 

NITROGLYCERINE 

Nitroglycerine or spirits of glonoin, is a colorless, oily 
liquid which has an odor and taste like alcohol. Nitro- 
glycerine combined with porous silica forms dynamite. Prep- 
arations 01 nitroglycerine should be very carefully handled, 
as it is apt to explode when dropped on the floor, when 
heated, or when rubbed vigorously. If it is accidentally 
spilled, it should be destroyed immediately, by pouring 
potassium hydroxide solution over it. 

A 1% alcohohc solution is used as a medicine, which 
should always be kept cool, as it may explode when exposed 
to heat. 

Preparations 
Spirits of Glyceryl Trinitrate 0.03-0.2 c.c. m. |-iii 

(Spiritus Glycerylis Nitratis) 
Nitroglycerin or Spirits of Glonoin 

This is a 1% alcohohc solution of nitroglycerine. It should 
always be fresh, as it decomposes very easily. 



258 MATERIA MEDICA 

Tablets of Nitroglycerine 0.0006 gm. gr. ^^ 

(Tabellae Trinitrini) 

(not official) 
1 to 2 tablets are given at a time. 

These are not as efficient as a solution of the drug, and 
they decompose very easily. 

SODIUM AND POTASSIUM NITRITES 

Sodium and potassium nitrites are salts formed by the 
combination of sodium or potassium, with nitrous acid. 

They produce the same effects as amyl nitrite or nitro- 
glycerine, with the following variations: 

1. Their effects appear very slowly, usually in about a 
half hour, but they last for several hours. 

2. They often cause nausea, belching of gas, and pain in 
the stomach, and occasionally diarrhoea. 

3o They do not cause as much headache, or flushing of 
the face as amyl nitrite or nitroglycerine does. 

Uses 

The nitrite of either sodiima or potassium, is suitable for 
continued use, to lower the blood pressure. 

Preparations 

Sodium Nitrite 0.06-0.12 gm. grs. i-ii 

(Sodii Nitris) 

This is given in solution or in tablets. 

Potassium Nitrate 0.06-0.5 gm. grs. i-viii 

(Potassii Nitras) 

This is not official and is rarely used. 

New and Non-official Preparations of the Nitrites 

Erythrol Tetranitrate 0.03-0.06 gm. gr. f-i 

(Tetranitrol) 

Mamiitol Hexanitrate 0.03-0.06 gm. gr. i-i 

These preparations are given in tablets, because they are 
explosive in fluid form. 



CIRCULATORY DEPRESSANTS 259 

These preparations produce the same effects as nitro- 
glycerine, but the effects appear more gradually and are more 
lasting. The effects usually appear in about 15 minutes and 
last for about 3 or 4 hours. 

SWEET SPIRIT OF NITER (SPIRITUS AETHERIS 
NITROSI) 

Sweet spirit of niter is a 4% solution of nitrous ether, or 
ethyl nitrite, in alcohol. It evaporates very easily and is 
inflammable. It should always be fresh, as old solutions 
decompose. 

ACTION 

Sweet spirit of niter produces the same effects as nitro- 
glycerine or the other nitrites. 

It dilates the blood vessels by paralyzing their muscle 
fibers, and causes: 

1. A rapid, soft, bounding pulse. 

2. Rapid breathing. 

3. Increased flow of urine, by relaxing the blood vessels 
of the kidneys. 

4. Increased secretion of sweat, by widening the blood 
vessels of the skin, so that the sweat glands are supplied 
with more blood from which to secrete perspiration. 

Poisonous Effects 

Inhalation of sweet spirit of niter has produced danger- 
ous, even fatal symptoms; resembling those produced by 
amyl nitrite. 

Symptoms 

1. Headache. 

2. Pain around the heart. 

3. Weak, slow pulse. 

4. Slow, shallow breathing. 

5. Muscular weakness. 

6. Collapse. 

Uses 

Sweet spirit of niter is used to increase the sweat and 
thereby to reduce fever, especially in children. It is given in 



260 MATERIA MEDICA 

small doses, well diluted; and the patient should be kept in 
bed, warmly covered. If the skin is kept cool, it increases 
the flow of urine 

Spirit of Nitrous Ether 1.0-4.0 c.c. 3i-i 

(Spiritus Aetheris Nitrosi) 
Sweet Spirit of Niter 



PART IV— DRUGS ACTING ON THE RESPIRATORY 

SYSTEM 

CHAPTER XIV 

DRUGS ACTING ON THE RESPIRATORY ORGANS 

The Respiration 

Breathing is an act whereby the lungs regularly inhale 
and exhale air about 18-20 times a minute. The mechanism 
of breathing consists of rhythmical alternate expansions and 
contractions of the lungs. 

Respiration consists of two phases: 

1. Inspiration. 

2. Expiration. 

The inspiration is the period during which the lung inhales 
air. It is caused by the downward movement of the dia- 
phragm, and the separation of the ribs. This makes the 
chest wider, so that the lungs expand and inhale air. 

The inspired air, which fills up the air sacs of the lungs, 
contains oxygen. This oxygen enters the blood, by passing 
through the walls of the air sacs into the capillaries of the 
lungs. It is then carried to the tissues and organs of the 
body by the circulation of the blood. 

The expiration is the period when the lungs exhale air. 
This is caused by the contraction of the diaphragm, which 
then moves upward, the contractions of the intercostal mus- 
cles (the small muscles between the ribs) and by the elasticity 
of the lung tissue. As a result of the contractions of these 
muscles, the chest becomes narrower, the lungs therefore 
contract and expel the air which they contain. The expired 
air contains carbon dioxide gas, and other waste products 
which have been brought to the lungs by the impure blood 
from the various tissues and organs of the body. 

Breathing is an automatic act: that is, it occurs inde- 

261 



262 MATERIA MEDICA 

pendently of all the influences produced by the other activ- 
ities of the bod}^ 

The most important part of the act of breathing, is the 
action of the diaphragm, a flat dome-shaped muscle sepa- 
rating the chest from the abdomen. The contractions of this 
muscle are controlled by impulses sent from a spot of gray 
matter in the medulla of the brain, along two nerves, the 
Phrenic nerves, which go to this muscle. This spot of gray 
matter is called the respiratory center. It is oiten called 
the vital center, because when it ceases to send impulses 
for breathing, death ensues. 

Death by hanging, or by the garotte (a method for execut- 
ing criminals in Spain), is caused by the destruction of 
the respiratory center in the medulla of the brain. 

The breathing can be modified, however, by impulses 
reaching the respiratory center along various nerves. 

Impulses affecting the larynx or the bronchi may reach 
the respiratory center of the medulla, along the Vagus or 
inhibitory nerves (these nerves also send fibers to the larynx, 
bronchi and lungs as well as to the heart). These impulses 
may cause the respiratory center to send impulses to increase 
the depth and frequency of breathing (by reflex action). 
Impulses such as those produced by cold air, cold water, etc., 
that reach the respiratory center from the skin, also increase 
the depth and frequency of breathing. 

Dyspnoea 

When it is difficult for a patient to get air into the lungs, 
the breathing becomes deep and labored and is called dys- 
pnoea. For example, when there is an obstruction to breath- 
ing, all the muscles attached to the chest, from the arms, 
neck and abdomen, contract forcibly. This makes the chest 
very much wider. The lungs therefore expand more than 
usual, thus making the inspiration much deeper. The con- 
tractions of the diaphragm and intercostal muscles are also 
increased; thereby making the chest much smaller with 
each expiration, so that more air is exhaled. 

Dyspnoea is often caused when there is no obstruction to 
breathing, but when the blood is very impure, and contains 



DRUGS ACTING ON THE RESPIRATORY ORGANS 263 

a great deal of carbon dioxide gas. This increases the im- 
pulses for breathing sent out from the medulla of the brain, 
thereby making the breathing deeper and more labored. 

Apnoea 

When the breathing is so slow and shallow that the move- 
ments of the chest can hardly be seen, it is called apnoea. 

Cyanosis 

Cyanosis is a blue color of the skin. This is caused by the 
dark color of the blood in the superficial blood vessels. This 
dark color is due to the methaemoglobin which the blood 
contains, as a result of an excess of carbon dioxide. It 
usually results when the patient does not get enough oxygen 
into the lungs to purify the blood. 

Coughing 

Coughing is a violent expiration preceded by a deep in- 
spiration. When a patient coughs, there is a deep inspira- 
tion at first, followed by violent contractions of the abdomi- 
nal muscles, which push the abdominal organs up against the 
diaphragm. The diaphragm then presses up against the 
lungs, and violently expels the air and secretions which they 
contain. The expiration is violent, because the larnyx is 
closed at the time when the expiration occurs. 

Coughing is a reflex act. It occurs when an object lodges 
in the larynx, when the bronchi are red and inflamed, or 
when they contain a great deal of mucus. These affect 
the nerve endings in the bronchi, which send impulses along 
the Vagus nerves to the respiratory center in the medulla. 
This center at once sends back impulses to cause violent ex- 
piratory contractions of the diaphragm, and coughing results. 

Drugs affect the respiration in two ways : 

1. Increasing the breathing : stimulation. 

2. Lessening the breathing : depression. 

Respiratory Stimulation 

When the respiration is stimulated, the breathing is 
usually deeper and faster. More air, and, therefore, more 
oxygen enters the lungs and then the blood. 



2o4 MATERIA MEDICA 

Respiratory stimulation is produced in several ways. 

1. By sending more impulses for breathing from the res- 
piratory center of the medulla of the brain. 

2. By causing redness, swelling and profuse secretion (ir- 
ritation) of the mucous membrane of the bronchi, impulses 
are sent along the Vagus nerves to the respiratory center 
of the medulla. This center at once sends back impulses 
to make the breathing deeper and faster (reflex action). 

3. By improving the condition of the blood, the medulla 
is supplied with better and pm*er nomishment. It is there- 
fore better able to send out more impulses for breathing. 
The breathing is then deeper and faster. Tonics such as 
iron, and arsenic often improve the breathing in this way 
after prolonged use. 

RESPIRATORY STIMULANTS 

The following drugs are used as respiratory stimulants. 

Atropine 

Caffeine 

Camphor 

Strychnine 

Alcohol 

Ammonia 

They make the breathing deeper and faster. They produce 
this effect by increasing the action of the respiratory center, 
so that more impulses for breathing are sent out from this 
center. 

Their general action has already been considered, or will 
be considered later. 

They are principally used in the treatment of collapse. 

Atropine and Caffeine are the best known respiratory 
stimulants. 

Strychnine is often used to increase coughing. 

Ammonia is given by inhalation, usually in fainting. 

ASPIDOSPERMA OR QUEBRACHO (not official) 

Aspidosperma or quebracho, is obtained from the bark of 
the Aspidosperma quebracho bianco, a South American tree. 



DRUGS ACTING ON THE RESPIRATORY ORGANS 265 

It increases the breathing by increasing the contraction of 
the diaphragm as a result of more impulses sent to it from 
the medulla. It also increases the secretions of mucous 
membranes, especially those of the bronchi. 

It is used principally to reheve difficult breathing and as 
an expectorant to increase cough and fluidify the mucus. 

Aspidospermine gr. /o - 3V is a mixture of all the active 
alkaloids and is the preparation used. 

OXYGEN 

Oxygen is a gas which forms 20% of ordinary air, and is 
necessary for the life of all animals. It is inhaled by the 
lungs with the inspired air. From the lungs, it enters the 
blood and combines with the haemoglobin of the red blood 
cells. These cells carry the oxygen to the various tissues 
and organs of the body, where it combines with some of the 
constituents of their cells, and thus enables the organs to 
carry on their various activities. 

ACTION 

Local action : Oxygen is a very good antiseptic, since most 
bacteria are unable to live in an atmosphere of pure oxygen. 

Internal Action 

When pure oxygen gas is inhaled, it enters the plasma of 
the blood, from the air sacs of the lungs. Some of the oxygen 
combines with the haemoglobin, forming oxyhaemoglobin, 
while part of it circulates uncombined, in the plasma. The 
formation of a greater amount of haemoglobin, gives the 
blood a brighter color, and the color of the skin then be- 
comes more ruddy. 

The improved condition of the blood makes the breathing 
slower, and slows and strengthens the heart action. 

Uses 

Oxygen is used in pneumonia, when the patient is blue 
and cyanotic, as a result of inability to obtain enough oxygen 
in the blood, because part of the lung is consolidated. The 



266 MATERIA MEDICA 

oxygen inhalations often relieve this blue color, and make 
the breathing easier. 

Oxygen is also given in potassium chloiate, and in illuminat- 
ing gas poisoning. These drugs combine with the haemoglo- 
bin of the blood, and prevent it from taking up oxygen from 
the lungs. The oxygen given in such cases, enters the plasma 
in sufficient quantity to supply the tissues with nourishment 
until the haemoglobin is freed from the poisonous substance. 

Administration 

Oxygen should always be given continuously; inhaled 
through a mask from a tank along the bedside. The in- 
halations should be stopped when the symptoms disappear. 

RESPIRATORY DEPRESSANTS 

The following drugs make the breathing slower and shaL 
lower. They will be described later, under their more iro 
portant effects. 

Opium 

Morphine 

Codeine 

Bromides 

Chloral 

Trional 

Tetronal 

Veronal 

Sulphonal 

Paraldehyde 

Amylene hydrate and other similar hypnotics 

Dilute Hydrocyanic Acid 

OXAPHOR (not official) 

Oxaphor is a 50% solution of oxy camphor, a derivative 
of camphor. Its principal effect is to make the breathing 
slow and shallow. 

It is used as a substitute for morphine in asthma, and 
difficult breathing (dyspnoea) from other causes. 

Oxaphor 2.0-3.0 gms. grs. xxx-xlv 



DRUGS ACTING ON THE RESPIRATORY ORGANS 267 

Expectorants may be divided into two groups : Stimulating 
and Sedative Expectorants. 

The stimulating expectorants are used to increase the 
expectoration and the coughing (violent expiration). This 
effect is produced by the profuse, more fluid secretion of the 
mucous membrane of the bronchial tubes. 

The excessive secretions of the bronchi, affect their nerve 
endings, thereby sending impulses along the Vagus nerves 
to the respiratory center in the medulla. This center at 
once sends back impulses to markedly increase the breath- 
ing, thus causing violent expiratory effects or coughing. 

The sedative expectorants are used to relax spasms of the 
bronchial muscles and thus to reheve spasmodic cough. 



STIMULATING EXPECTORANTS 

AMMONIUM CHLORIDE (AMONII CHLORIDUM) 

Ammonium chloride is an alkaline salt formed by the com- 
bination of ammonia and hydrochloric acid. 

It is used principally to increase the cough and expectora- 
tion. 

Poisonous doses cause the following symptoms: 

1. Nausea and vomiting. 

2. Bleeding from the mucous membranes, 

3. Collapse. 

Preparations 

Ammonium Chloride 0.3-1.0 gm. grs. v-xv 

(Amonii Chloridum) 

Troches of Ammonium Chloride 
(Trochisci Amonii Chloride) 

Each contains about 0.1 gm. (grs. ii) of ammonium 
chloride, with 0.25 gm. (grs. iv) of licorice extract, and some 
syrup of tolu. 



268 MATERIA MEDICA 

Liquor Amonii Anisatus ^Solution of Ammonia and Anise) 

This is a preparation consisting of the follo^Ying ingred- 
ients: 



Oil of anise 


1 part 


Ammonia water 


5 parts 


Alcohol 


24 parts 



It is not official in this country, but it is extensively used, 
and is a very valuable preparation. It is an excellent 
stimulating expectorant and is given in doses of 0.6 to 2.0 
gms. (m. x-xxx). 

SENEGA (SNAKE ROOT) 

Senega is obtained from the root of the Polygala senega, 
or senega snake root, a plant growing in the middle and 
southern United States. 

Uses 

Senega is used principally as a stimulating expectorant 
and somewhat as a diuretic. 

Preparations 

Fluidextract of Senega 0.6-1.0 c.c. m. x-xv 

(Fluidextractum Senegae) 

S5rrup of Senega 4.0-8.0 c.c. 5i-ii 

(Syrupus Senegae) 

Senega is also contained in the compound syrup of squills. 

QUILLAJA (SOAP BARK) 

Quillaja, panama bark or soap bark is obtained from the 
inner bark of the Quillaja saponaria, a South American tree 
which grows principally in Chih. Its active principles are 

saponins (soapy glucosides). 

Uses 

Quillaja is occasionally used as an expectorant and to 
cause vomiting. It is used by pharmacists to emulsify 



DRUGS ACTING ON THE RESPIRATORY ORGANS 269 

(break up into fine globules) oils and other oily substances. 
It is largely used for cleaning silk and other fabrics. 

TERPIN HYDRATE 

Terpin hydrate is a colorless crystaUine substance made 
from the oil of turpentine, by the action of nitric acid, 
alcohol and water. 

Terpin hydrate is used principally as an expectorant, as an 
antiseptic in gonorrhoea, and in cystitis (inflammation of the 
bladder). 

Preparations 
Terpin Hydrate 0.06-0.25 gm. grs. i-iv 

Terpini Hydras 

BALSAM OF TOLU (BALSAMUM TOLUTANUM) 

Balsam of tolu is a reddish yellow sticky semi-solid sub- 
stance, which dissolves in alcohol, but not in water. 

Its action is due to the benzoic acid which it contains. 

It is used principally as an expectorant. It forms an 
ingredient of many cough mixtures. 

Preparations 

Balsam of Tolu 0.06-0.3 gm. grs. i-v 

(Balsamum Tolutanum) 

Syrup of Tolu 15.0-30.0 c.c. 5^ 

(Syrupus Tolutanus) 

SANGUINARIA (BLOOD ROOT) 

Sanguinaria or blood root is obtained from the under- 
ground stems of the Sanguinaria canadensis, gathered in the 
autumn when its leaves are dead. It is used principally as 
an expectorant. 

OTHER DRUGS USED AS EXPECTORANTS 

Ipecac and Apomorphine in small doses are occasionally 
used to increase and fluidify the mucus. 

Apocodein Hydrochloride 0.06 gm. gr. i 

(Not official) 

This is occasionally used as an expectorant. 



270 MATERIA MEDICA 

SEDATIVE EXPECTORANTS 

PRUNUS VIRGINIANA (WILD CHERRY) 

Prunus Virginiana is obtained from the bark of the wild 
cherry tree. 

Its active principles are amygdalin, a glucoside, and a 
ferment, emulsin. These two substances if rubbed together 
form prussic acid (hydrocyanic acid). 

Prunus Virginiana is often given to increase expectora- 
tion and lessen coughing, together with other cough medi- 
cines. 

Syrup of Prunus Virginiana 4.0-15.0 c.c. 3i-iv 

(Syrupus Pruni Virginianae) 15% strength 

GLYCYRRHIZA (LICORICE ROOT) 

Licorice forms an ingredient of many cough mixtures. 
It lessens coughing by protecting the mucous membrane of 
the throat and larynx and thus avoiding irritation. The 
following is the most commonly used preparation contain- 
ing Licorice: 

Brown's Mixture 2.0-10.0 c.c. Sj-iii 

(Mistura Glycyrrhizae Compositus) 

This mixture is a soothing cough mixture which also 
contains opium. 

GRINDELIA 

Grindelia is obtained from the leaves and flowers of 
Grindelia robusta, and Grindelia squarrosa, plants which grow 
on the western coast of the United States. 

It is principally used to relieve spasmodic cough by relax- 
ing the spasm of the involuntary muscles of the bronchial 
tubes. 

LOBELIA 

Lobelia or Indian tobacco, is occasionally used to reheve 
the spasmodic cough of whooping cough and asthma. It 
is a dangerous drug, and the patient should be carefully 



DRUGS ACTING ON THE RESPIRATORY ORGANS 271 

watched when it is given. Its action will be described under 
its more important effects (see page 430). 

Other Expectorants 

The following drugs are also frequently used as expector- 
ants. Their action has already been considered, or will be 
considered later. 

Squills 

Benzoin 

Eucalpytus 

Turpentine 

Marrubium (horehound) 

Serpentaria 



PART V— DRUGS ACTING ON THE CENTRAL NERVOUS 

SYSTEM 

A. DRUGS WHICH STIMULATE THE CENTRAL 
NERVOUS SYSTEM 

CHAPTER XV 

PHYSIOLOGY OF THE NERVOUS SYSTEM 

The nervous system, or the cerebro-spinal system, con- 
sists of a number of organs which regulate the activities of 
all the other organs and tissues of the body. 

The nervous system increases or diminishes the activities 
of the various organs of the body. It harmonizes the actions 
of one organ with those of another, and the activity of the 
body with its surroundings. 

The nervous system consists of the brain, the spinal cord, 
the nerves, and nerve endings. 

The brain 

The brain is an organ situated in the skull. It consists 
of an outer part which has numerous folds, called convolu- 
tions. This outer part is of a gray color and consists of 
numerous microscopic cells. 

The inner part of the brain is white in color, and consists 
of numerous microscopic fibers coming from, or going to, 
the cells in the gray matter. 

The cells of the gray matter are the active parts of the 
brain. 

The brain is divided into three parts: 

1. The Cerebrum 

2. The Cerebellum 

3. The Medulla Oblongata 

The cerebrum forms the largest part of the brain and is 
often called the fore brain. 

The cerebellum is much smaller than the cerebrum, and 

272 



PHYSIOLOGY OF THE NERVOUS SYSTEM 273 

is situated immediately behind the cerebrum and is often 
called the hind brain. 

The medulla oblongata joins the cerebrum to the spinal 
cord and is often called the mid brain. 

Action of the Cerebrum 

The cells of the gray matter of the cerebrum do three 
kinds of work: 

1. Sensory 

2. Motor 

3. Mental 

The sensory work of the brain consists of receiving im- 
pulses or messages from the various organs of the body. 

The motor work of the brain consists of sending out im- 
pulses or messages to the various organs of the body. 

The mental work of the brain consists of associating im- 
pulses and impressions received, or those sent out by one 
group of cells of the brain with the impressions of another 
group. 

SENSORY ACTIVITY OF THE BRAIN, OR THE IMPULSES 
OR MESSAGES THAT ARE RECEIVED BY THE BRAIN 

The body is kept constantly aware of its surroundings, 
and objects about it, by the impulses received through its 
various senses. 

These impressions are received through the various senses. 
There are five kinds of sensory impressions received by the 
brain : 

1. Sense of Sight 

2. Sense of Hearing 

3. Sense of Smell 

4. Sense of Taste 

5. Sense of Touch 

Sight 

The impressions received through the sense of sight are 
received through the eyes, which are complicated organs 
attached to the ends of nerves going to the brain, the optic 
nerves. Through the eyes, the brain learns the character of 



274 MATERIA MEDICA 

various objects about it, their size, their shape and color. 
The body is thus able to avoid dangerous objects. It is also 
able to distinguish between light and darkness, and in this 
way we can tell the time of day, etc. 

Hearing 

The impressions of hearing are received through the 
ears, by means of nerves coming from the ears to the brain. 
Through the impulses of hearing, the body appreciates 
pleasant and unpleasant sounds. It is able to avoid dangers, 
and to respond to various impressions of sound, such as 
speech, music, etc. 

Smell 

Through the sense of smell the brain is able to appreciate 
pleasant and unpleasant odors by means of nerves coming 
from the nose to the brain, the olfactory nerves. Poisonous 
foods can thus be avoided, pleasant and unpleasant odors 
recognized, etc. 

Taste 

Through the sense of taste, palatable and unpalatable 
food substances are recognized, by means of impulses sent 
from the tongue to the brain along various nerves. The en- 
joyment of food is thus helped, and poisonous foods may be 
avoided. 

Touch 

The brain receives impressions through the sense of 
touch by means of numerous nerves which reach it either 
directly or through the spinal cord. The impressions are 
received by numerous nerve endings scattered over every 
part of the skin, from which they are carried along the vari- 
ous nerves to the brain or spinal cord. 

Four different kinds of impressions are received by the 
nerve endings in the skin. Many of these sensations are 
received by special nerve endings, and reach the brain or 
spinal cord by separate nerve fibers. 

1. Sensation of touch: This is a sensation whereby the 
consistency and shape of an object is determined by feeling 
it; whether it is hard, soft, smooth or rough; whether it is 
xound, square, etc. 



PHYSIOLOGY OF THE NERVOUS SYSTEM 275 

2. Sensation of pain: This is an unpleasant sensation, 
whereby the body is able to avoid injurious objects, and by 
which we are made aware of various diseased conditions, 
such as inflammation, injuries, etc. 

3. Sensations of temperature: This is a sensation whereby 
the brain is able to determine whether an object is hot or 
cold, by means of impressions received by the brain from 
various nerves coming from special nerve endings in the skin. 

4. Muscular sense : This is an important sensation whereby 
the brain is constantly informed of the position of the various 
joints of the body; such as the joints of the extremities. 
This enables us to walk about, without continually watch- 
ing our steps, or to button our clothes without watching 
this act. In some diseases such as locomotor ataxia, where 
this sense is affected, the patient is unable to walk without 
watching his steps. 

All the impressions received by the brain through the 
various senses are stored up in the cerebrum. When a 
similar impression is received again, it is at once recognized. 
For example — an object or color when seen again, is recog- 
nized as having been seen before, and under which circum- 
stances it was seen. 

MOTOR FUNCTIONS OF THE BRAIN 

The impulses sent out from the brain are principally: 

1. Impulses for Motion 

2. Impulses for Speech 

Impulses for Motion 

Certain areas of the gray matter of the brain contain cells 
which constantly send out impulses to make the muscles con- 
tract, and thereby produce the various movements of the 
body. This part of the brain is called the motor center. 
There are two such centers; one on each side of the brain^ 
Each side sends out impulses to cause motion of the opposite 
side of the bod}'-, and to regulate the movements of the 
extremities on that side of the body. 



276 MATERIA MEDICA 

Impulses for Speech 

There is an area of gray matter m the cerebrum, which 
sends out impulses to cause the complicated movements of 
the muscles of the larynx causing speech. 

The speech center is situated only on one side of the 
brain, usually on the left, except in left-handed individuals, 
in whom it occurs on the right side. 

MENTAL ACTIVITIES OF THE BRAIN 

The following activities of the brain are called mental 
activities. They are not due to the action of any particular 
part of the brain, but to the action of a number of areas to- 
gether, or by the action of one part of the brain upon another. 

1. Consciousness 

2. Attention 

3. Memory 

4. Reasoning 

5. Judgment 

6. Emotion 

7. Imagination 

8. WiU power 

Consciousness 

By consciousness, we mean that we are aware of objects 
and persons about us, of the time of the day, of the place 
where we are, etc. 

Consciousness depends upon our sensations; because the 
sensations inform the brain of our siu"roundings. When the 
sensations are increased, consciousness is increased; when 
they are diminished, consciousness is lessened. For ex- 
ample — ^morphine, a drug which lessens the appreciation of 
the sensations, produces unconsciousness, or sleep. 

Attention 

Attention is an activity whereby the brain keeps on 
receiving, sending out, and associating impulses only of one 
particular kind, at a certain time; that is, we are conscious 
only of a certain object. For example — ^when reading a 
certain book, we may have our attention so fixed on it, that 



PHYSIOLOGY OF THE NERVOUS SYSTEM 277 

we may not see anyone coming into the room, nor objects 
about us. We may hear what anyone says, but yet not 
really know what was said. 

Memory 
Memory is an act of the brain whereby an impression 
that has been received, or an impulse that has been sent out 
some time ago, either by our sensations or by our actions or 
an experience, is recalled again. For instance, we may 
remember that on a certain day we saw a famous parade. 
The impression of the parade is so fixed in our mind that it 
can easily be recalled. 

Reasoning 

Reasoning is an act of the brain whereby old impressions 
that have been stored up in the brain, either by experience 
or study, or that were received through our sensations, are 
combined to form a definite conclusion. For example — it is 
by reasoning that we find out the cost of ten apples when 
we know the cost of four. We have learned that we must 
first find the cost of one apple. This fact has been stored in 
our brain by study. We have also learned that ten is ten 
times one. By combining these two impressions, we find 
the cost of one apple by division, and then multiply the 
result by ten. 

Judgment 

Judgment is a function whereby we are able to determine 
the relation between old impressions stored up in the brain by 
experience, by study or by the sensations, and the impressions 
just occurring in the brain through our senses. For example, 
on seeing a light burning, we may remark ^ ' the light is bright ' ' ; 
that is, we judge it by other similar impressions. 

The foregoing mental activities of the brain are often called 
the higher functions of the brain, because when they are 
highly developed they are usually an indication of the de- 
gree of intelligence of an individual. 

Emotion 

Emotion is a subjective feeling which results from expec- 
tation, from knowledge and from impressions previously 
received by the brain. As a result of this feeling the brain 



278 MATERIA MEDICA 

modifies the action of the body, the consciousness and the 
motor impulses sent out from the brain. For example, in 
watching an athletic contest, when our favorite team is suc- 
cessful, we shout, we laugh, we jump, we wave flags; in 
short, we are more active and more conscious. More im- 
pulses are sent out from the brain as a result of the feelings 
we experience from the tense expectation of victory and its 
effects as learned by previous experience. 

The grief at the death of a friend or a relative, makes us 
less active, less conscious, less interested in objects about us, 
because of the impressions stored up in the brain as a result 
of the companionship of the deceased, and the contempla- 
tion of conditions due to his absence. 

Emotions are of three kinds: 

1. Emotions causing pleasant sensations. These emotions 
make the individual more satisfied ; he is more active, more 
talkative, his spirits are brightened, he is gay, jolly and 
laughs easily. 

The first example of the successful victory given above, 
is such an emotion. The most common pleasant emotions 
are joy and satisfaction. 

2. Emotions causing unpleasant sensations. These emotions 
make the body less active. They often cause tremors of the 
muscles, crying, violent movements of the muscles or ex- 
tremities; the individual moves constantly about, has a loss 
of appetite, etc. The second example of the grief at the 
death of a friend is such an emotion. 

The most common emotions of this kind, are grief, angerj 
fear, remorse. 

3. Complex emotions. These consist of subjective feelings 
that cause a mixture of the first and second groups of symp- 
toms. Complex emotions are often called the tender emo- 
tions. The most common emotions of this kind are sorrow, 
pity, gratitude, reverence, benevolence, love, sympathy. 

Imagination 

Imagination is an act whereby the brain is conscious of 
objects that cannot be appreciated by the senses. The ob- 
jects we imagine are really new combinations of old impres- 



PHYSIOLOGY OF THE NERVOUS SYSTEM 279 

sions that have been stored up in the brain by the sensa- 
tions, such as sight; hearing, touch, etc. ; by study, by read- 
ing or by experience. 

Every new work of the imagination such as a novel, a 
play, an opera, etc., is really a new combination of events, 
impressions, and experiences, encountered by the author 
in his lifetime, or gained by reading or study. There is 
therefore, really '^nothing new under the sun." 

Will Power or Inhibition 

Will power or inhibition is an act of the brain whereby all 
its activities, which have just been described, as well as all 
the activities of the spinal cord, are regulated, controlled 
or kept in check. This is one of the highest functions of the 
brain. 

For example, we may have an experience which may 
increase one of our emotions such as grief. Yet we may not 
manifest this grief because our emotion may be controlled 
or inhibited by our will power. 

One of the emotions such as anger, may be stimulated to 
such an extent, as to cause the brain to send out impulses 
to strike the individual who may be the cause of our anger. 
We do not strike him, however, because our emotions are 
kept in check by the inhibitory action of the brain, or will 
power. 

All the sensory, motor or mental activities of the brain 
when once performed, leave a record in the brain which may 
be revived at some future time. 

ACTION OF THE CEREBELLUM 

The cerebellum controls our equlibrium, that is, it regu- 
lates our movements in a straight line. It enables us to 
move forward, backwards, from side to side and up and 
down, without staggering. 

When the action of the cerebellum is disturbed, the patient 
usually staggers. If one side is affected, the patient usually 
staggers to one side. 



280 MATERIA MEDICA 

ACTION OF THE MEDULLA OBLONGATA 

The medulla oblongata joins the brain to the spinal cordo 
It consists of small areas of gray matter within, and white 
matter without. The areas of gray matter are called centers. 
Each center controls a certain action of the body, and con- 
stantly sends out impulses along certain nerves to cause or 
regulate these activities of the body. 

Most of these activities are vital, because without them 
life cannot go on. The following are the most important 
centers in the medulla: 

1. The respiratory center, which controls breathing. 

2. The cardio-accelerator center, which makes the heart 
beat faster. 

3. The vagus or cardio-inhibitory center, which makes the 
heart beat slower. 

4. The vaso-motor center, which controls the width of 
the blood vessels. 

5. The vomiting center, which sends out impulses to cause 
vomiting. 

ACTION OF THE SPINAL CORD 

The spinal cord is a long cord-Hke structure situated in 
the spinal canal, running from the skull to the sacrum. It 
has numerous nerves attached to it, which carry impulses 
to and from the cord. 

The spinal cord consists of gray matter within, which 
contains all the cells, and white matter without, consisting 
of the fibers from these cells. 

The function of the spinal cord is to cause an organ of the 
body to act, as a result of an impulse received from that or- 
gan, or from another part of the body by the spinal cord. 
Such an action, which depends upon an impulse received, is 
called a reflex action. (It is a reflected action, because it re- 
flects the impulse received, by another impulse which is 
sent out.) 

For example, when the bladder is full of urine, impulses 
are sent from its inner wall to the spinal cord, which at once 
sends impulses back to cause the muscles in the bladder to 
contract, thus expelhng the urine from the bladder. 



PHYSIOLOGY OF THE NERVOUS SYSTEM 281 

When a hot object is apphed to the skin of the arm, an 
impulse is at once sent to the spinal cord, which imme- 
diately sends out another impulse to make the muscles of 
the arm contract, and the arm is drawn away. 

Reflex actions are controlled by the inhibitory or check- 
ing action of the brain. 

For example, when the bladder is full, it is ordinarily 
prevented from emptying itself for a time. This is due to 
the inhibitory action of the brain which holds the reflex 
action in check. 



THE SYMPATHETIC SYSTEM 

This consists of a chain of small nodules which extend on 
either side of the spinal column and are called ganglia. Each 
nodule contains a group of small nerve cells which act as 
relays for many of the nerve impulses passing from the 
medulla and spinal cord. These impulses are first trans- 
mitted along nerve fibres to the sympathetic ganglia and 
thence by other nerves to the organs or tissues to which they 
carry impulses. The following are the nerve impulses which 
pass through the sympathetic system: 

1. The nerves which dilate the pupil of the eye. 

2. The nerves which regulate the caliber of the small 
blood vessels (Vaso-motor nerves) . 

3. The Accelerator nerves, which increase the heart ac- 
tion. 

4. The nerves going to the lungs. 

5. The nerves going to all the organs in the abdomen and 
pelvis. These probably transmit impulses to lessen their con- 
tractions. 



THE NERVES 

The nerves are bands of white fibers, which go to, and 
come from the brain and spinal cord. 



282 MATERIA MEDICA 

The nerves that carry impulses to the brain and spinal 
cord, are called sensory or afferent nerves. Those that carry 
impulses from the brain and spinal cord are called efferent 
nerves. The efferent nerves carry impulses to make the 
muscles contract, and to increase the secretion of the se- 
cretory glands. 

The nerves terminate in the skin, the muscles, or the 
various organs of the body, by means of small microscopic 
bodies called nerve endings. 



CONSCIOUS, SUBCONSCIOUS AND REFLEX ACTION 

The activities of the nervous system are of three kinds: 

1. Conscious 

2. Subconscious 

3. Reflex 

Conscious actions are activities of the brain, of which we 
are aware; they occur only in the brain. 

Subconscious actions are activities taking place in the 
brain while we are conscious of something else. We usually, 
however, later become conscious of subconscious ac- 
tivities. 

For example, while we are conversing about a certain 
topic, we wish to recall the name of a particular individual. 
We are unable to do so, however, after considerable attempts, 
and we then give up the attempt. Some time later, while we 
are occupied with another topic, the name suddenly occurs 
to us, and we then remember the name we had been trying 
to recall. 

A process has been going on in the brain, without our 
being aware of it, which has brought back the memory of 
the name. 

Reflex action is an activity whicn is the result of a stimulus 



PHYSIOLOGY OF THE NERVOUS SYSTEM 283 

received by the sensory nerves from the skin or other parts 
of the body. 

Reflex actions may occur in the brain and spinal cord. 
In the spinal cord all the activities are reflex. 

MODE OF ACTION OF THE NERVOUS SYSTEM 

The action of the nervous system can be easily understood, 
if we compare it to a telephone system. 

A telephone system consists of a central station, which 
receives messages from wires leading to, and coming from 
this central station. Messages are sent to the central sta- 
tion, by means of the transmitter, and they are received 
through the receiver. 

The central station keeps all the subscribers in touch 
with one another. Some subscribers do not communi- 
cate directly with the central station, but by means of 
a sub-station, or a private switchboard. This sub-station 
must first be communicated with before reaching the 
central station or any of the subscribers connected 
to it. 

The nervous system acts in a similar manner (see dia- 
gram, page 284). 

The brain is the central station, which keeps the vari- 
ous organs of the body in communication with one an- 
other. 

Some organs, such as the eye, the ear and the nose, com- 
municate directly with the brain, through their nerves. In 
fact all the cranial nerves comm^unicate directly with the 
brain. These nerves correspond to the wires leading directly 
to or from the central station of the telephone system. 

The sensory nerve endings correspond to the transmitters 
which send impulses along the sensory nerves to the central 
station, the brain. 

The motor or secretory nerve endings correspond to the re- 
ceivers which receive impulses from the brain, tne central 
station. 

The spinal cord corresponds to the sub-station or switch- 
board. 




284 MATERIA MEDICA 

Some parts of the body do not communicate directly with 
the brain, the central station, but through the spinal cord, 
which corresponds to the sub-station or switchboard. All 
the impulses from the skin of the trunk and extremities 
reach the brain in this way. Ail the impulses for motion 
reach the muscles of the extremities and trunk indirectly, 
through the spinal cord. 

Just as an institution, having a private switchboard, can 

Cranial Sensory Nerve . . Sensory Nerve. 

BRAIN 1 ^~' „ f"^'"^- , . 

_ . — ~ > ■ ^ Motor orSecreforii 

Cranial Motor NervQ ^ Nerve Etidm^. 

Nerve. Fibers 
Connecfincj the Bjnsiin 
and Spinal Cord, 

Sen. %oru Nerve; m Spinal Sensory Nerve > — < 

Ending. ^ ^ 7SPINAL\ 

^otor or Secretory ^ < - l CORD , 

Nerve Endiri(^. ^ Spinal Motor Nerve \„.^ 

Diagram illustrating the action cf the nervous system. The arrows 
indicate the direction in which the impulses travel 

connect any of its individuals in one part of the building 
with other individuals in a different part of the building; so 
an impulse going to the spinal cord, may cause another 
impulse to be sent out from the spinal cord, without such 
an impulse being sent to, or coming from the brain. Such 
an action is a reflex action. 

Mode of Action 

For example: When an automobile is seen coming along 
the street at great speed, we at once get out of its way. The 
impulse received by the eye when the automobile is seen, is 
sent to the brain. 

The brain then sends out impulses to the spinal cord, 
which in turn sends impulses to the muscles of the lower 
extremities causing them to contract. The legs are then 
moved and we get out of the way of the automobile. 

The eyes are thus kept in communication with the muscles 
of the lower extremities. 

Considering the nervous system as a telephone system, 
the message (the sight of the automobile) is sent to the 



PHYSIOLOGY OF THE NERVOUS SYSTEM 285 

cencraJ station, the brain. This at once sends a message to 
the sub-station, the spinal cord, which in turn sends a mes- 
sage to the lower limbs, causing them to move. 

EFFECTS OF DRUGS ON THE NERVOUS SYSTEM 

Drugs affect the nervous system in two ways: 

1. Increasing its activity, stimulation. 

2. Lessening its activity, depression. 

CEREBRAL STIMULATION 

Drugs may increase the activity of the entire brain, or 
only of certain areas of it. In the latter case, only some of 
the activities of the brain are increased, while others may 
be normal or even diminished. 

Stimulation of the Sensory Activities of the Brain 

When the action of the areas of the brain which receive 
sensory impulses, is increased, the brain receives more 
impulses through the various senses. The patient is there- 
fore brighter, wider awake, and appreciates his surround- 
ings better; that is, he is more conscious, because conscious- 
ness is the result of the sensations received through the 
various senses. 

The patient appreciates all the various sensations better; 
such as the sense of pain, touch, heat, cold, etc. 

Illusions and Hallucinations 

When the various sensory areas of the brain are made 
very active, certain inipressions which had been received 
through the various senses and stored up are revived. The pa- 
tient then has sensations which do not exist. For example — 
stimulation of the area for receiving impulses of sight, 
makes the patient see objects that do not exist. Such im- 
pressions are called hallucinations or illusions. In this ex- 
ample they are illusions or hallucinations of sight. 

If the area for the reception of sound is thus overstim- 
ulated, the patient may hear sounds, noises or voices, that 
do not exist. These are called hallucinations of sound. 

If the area for the appreciation of the sense of touch ia 



286 MATERIA MEDICA 

over-stimulated, the patient may feel things that do not 
exist, such as objects or animals creeping over the skin. 
These are called hallucinations of touch. This often occurs 
in alcoholic delirium, or delirium tremens. 

If the area of the brain which receives sensations of taste 
or smell is thus affected, the patient may taste or smell 
objects that do not exist. These are called hallucinations or 
illusions of taste or smell. 

Stimulation of the Motor Areas of the Brain 

When the areas of the brain which send out impulses for 
motion, are stimulated, the patient moves about more, and 
is more active, because of the greater number of impulses 
for motion which are sent out from the brain. 

Convulsions 

When the motor areas of the brain are over-stimulated, 
however, the unpulses for motion are so active, and so many, 
that instead of regular coordinated movements of the 
muscles, violent contractions, or convulsions result. 

Convulsions are of two kmds: Clonic and Tonic. 

Clonic convulsions are repeated single contractions of 
the muscles of the body. 

Tonic convulsions are prolonged contractions of the mus- 
cles of the body. During a tonic convulsion the muscles 
are very rigid. 

Stimulation of the Speech Center of the Brain 

When the activity of the speech center of the brain is 
increased, the patient becomes more talkative. 

Delirium 

When the activity of the speech center of the brain is 
very greatly increased, for example: by drugs, or by the 
poisons of infectious diseases, all the impressions and mem- 
ories for speech that have been stored up in the brain are 
sent out. 

The patient talks continuously ; of numerous objects that he 
has seen in the past, or that he seems to see at present. He may 
speak various words of different languages that he has heard 
at some time in his life, etc. This condition is called delirium. 



PHYSIOLOGY OF THE NERVOUS SYSTEM 287 

The same causes which increase the activity of the speech 
center, also increase the activity of the motor areas of the 
brain. Dehrium is often accompanied then, by excessive 
movements of the muscles and often by convulsions. 

Stimulation of the Mental Functions of the Brain 

Drugs which increase the activity of the brain also in- 
crease the mental activities of the brain. When these 
activities are increased, the patient is able to concentrate 
his mind better and pay closer attention. The reasoning 
and judgment are also increased and the memory is better. 

When the imagination is increased, the patient is better 
able to combine old impressions into new ones. They may 
have visions of various objects, places and people. They 
may imagine new kinds of sounds, etc. 

Often the imagination is increased, while the activity of 
the sensory areas of the brain is lessened. The patient is 
then unconscious (asleep) but the increased activity of the 
imagination results in various dreams. Such effects are 
produced by morphine. 

When the inhibitory action of the brain is increased, the 
patient is able to control the various activities of the brain 
and other organs better. 

STIMULATION OF THE MEDULLA OBLONGATA 

When the activity of the medulla of the brain is increased, 
the various centers which it contains become more active. 
If the respiratory center is stimulated, the breathing is 
deeper and faster. 

If the cardio-accelerator center is made more active, the 
heart beats faster and stronger. 

If the vagus or cardio-inhibitory center is increased in ac- 
tivity, the heart beats slower. 

If the vaso-motor center is more active, the blood vessels 
become narrower, and the pulse is tense, and the blood 
pressure is greater. 

If the vomiting center is made more active, the patient 
usually vomits frequently and profusely. 



288 MATERIA MEDICA 

The entire medulla is rarely stimulated. Most drugs 
affect only certain centers in the medulla. 

STIMULATION OF THE SPINAL CORD 

When the spinal cord is made more active the patient is 
able to respond to all stimuH and impressions received by 
the senses, more rapidly and with greater force. 

For example: When the spinal cord is stimulated, the 
application of a hot object to the hand will cause the arm to 
be forcibly drawn away, and m.ay even cause convulsions, if 
the spinal cord is greatly stimulated. 

Drugs which increase the activity of the spinal cord, such 
as strychnine, act as a tonic. This is due to the improvement 
in the activities of various organs of the body because of 
the increased reflex action. Such actions as breathing and 
movements of the bowels, which are reflex actions, or which 
are increased by reflex action, are improved. 

STIMULATION OF THE NERVES AND NERVE ENDINGS 

If the sensory nerves or nerve endings are made more 
active, the patient becomes more sensitive to pain, to heat 
and to cold. There may even be tingling in the areas of 
skin affected, a feeling as if there was some object creeping 
on the skin (formication). 

If the efferent or motor nerves are thus aft'ected, the 
patient may have twitchings of the muscles, if they are 
motor nerves or nerve endings. If the secretory nerves 
or nerve endings are thus affected, the glands suppHed by 
these nerves secrete more profusely. 

EFFECTS OF EXCESSIVE STIMULATION 

When drugs increase the activity of the brain too much 
(over-stimulation), which often results from excessive doses 
of cerebral stimulants, the effects are those of lessened ac- 
tivity or depression. 

The patient becomes less conscious, falls asleep, or becomes 
still more unconscious, and finally goes into a stupor (a deep 
sleep from which he can be awakened with difficulty). 
Later, ccma develops (a deep sleep from which the patient 
cannot be aroused at all). 



CEREBRAL DEPRESSION 

Drugs may lessen the activity of the entire brain or only 
of certain areas of it. In the latter case, only some of the 
activities of the brain are lessened, while others may be 
normal or even increased. 

Depression of Sensation 

When the activity of the sensory areas of the brain are 
lessened, fewer sensory impulses reach the brain. 

The sense of pain, touch, heat, cold, sight and hearing and 
all other sensations are lessened. Many drugs, for example, 
morphine, relieve pain in this way. 

Since consciousness depends upon the sensory impulses 
received by the brain, when the reception of these impulses 
is lessened, the patient is less conscious, or may even be 
unconscious or asleep. 

In overactivity of a cerebral depressant, stupor and coma 
result. 

Motor Depression 

When the action of the motor areas of the brain is lessened, 
fewer impulses for motion are sent out from the brain. The 
patient is then less active, he usually walks about more 
slowly and when the effect is marked he may even remain 
in one place without any desire to change his position. 

Depression of the Speech Center 

When the activity of the speech center is lessened, the 
patient is less talkative; and when he does speak, he is apt 
to speak slowly and in a low voice. 

Depression of the Mental Functions of the Brain 

Drugs which lessen the mental activities of the brain make 
the patient dull and stupid. He is unable to fix his atten- 
tion or concentrate his mind on any subject, for any length 
of time. The reasoning is very slow and poor, the memory 

289 



290 MATERIA MEDICA 

is very poor and the patient is very forgetful. He is usually 
dull and unemotional. 

When the inhibitory action or will power is lessened, 
ihe patient is unable to control the various activities of his 
brain and other parts of the body. 

For example, the action of alcohol begins by lessening 
the will power. It therefore removes the inhibition from 
the speech center. It makes the patient talkative, and the 
individual often says things that may be fooHsh or improper. 

DEPRESSION OF THE MEDULLA 

Drugs which lessen the activity of the medulla usually 
lessen the action of its various centers. 

'WTien the action of the respiratory center is lessened, 
the breathing is slower and shallower. 

Lessening the activity of the cardio-accelerator center 
lessens the impulses which make the heart beat faster, so 
that the heart then beats slower and weaker. 

When the action of the vagus or cardio-inhibitory center 
is lessened, fewer impulses for slowing the heart reach it. 
The heart therefore beats faster. 

When the activity of the vaso-motor center is lessened, 
ihe blood vessels become widened and the skin becomes 
flushed. The pulse is therefore softer and more bounding in 
quality. 

DEPRESSION OF THE SPINAL CORD 

When the activity of the spinal cord is lessened, the patient 
usually responds to stimuli less readily. In other words, 
the reflex action is lessened. It therefore lessens the activity 
of various organs of the body such as the movements of the 
bowels, breathing, etc., which are helped by reflex action or 
which act in a reflex manner. 



DEPRESSION OF THE NERVES AND NERVE ENDINGS 

When the activity of the sensory nerves or their nerve 
endings is lessened, the patient does not appreciate sensations 



PHYSIOLOGY OF THE NERVOUS SYSTEM 291 

such as touch, temperature, pain, etc. It often produces 
numbness in the areas suppHed by these nerves. 

When the activity of the efferent nerves is lessened the 
following results are produced : 

Lessened contractions of the muscles if they are motor 
nerves. If the depression is very great, as in overactivity 
of the drug, paralysis results. 

Lessening the activity of the secretory nerves or their nerve 
endings, results in diminished secretion of these glands. 



CHAPTER XVI 

BRAIN AND SPINAL CORD STIMULANTS 

CAFFEINE (CAFFEINA) 

Caffeine is a white crystalline powder, the active alkaloid 
of the coffee bean, Coffea arabica. It is also found in tea 
leaves, thea chinensis of China; in Paraguay tea of Argen- 
tine and in the kola nut of Central Africa and the guarana 
paste of Brazil. 

Coffee was originally used by the Arabians, but it is now 
a universal beverage. It causes the same effects as caffeine, 
for the action of coffee is due principally to the caffeine 
which it contains. 

Coffee and tea are very commonly used beverages. They 
are infusions of the coffee bean or of tea leaves. The coffee 
bean contains about f % of caffeine. A cup of coffee con- 
tains about 0.1-0.2 gm. (grs. i-iii) of caffeine. Coffee has a 
laxative effect because of volatile oils which it contains. 

Tea contains about IJ to 2% of caffeine. A cup of tea 
also contains 0.1-0.2 gm. (grs. i-iii) of caffeine. Tea con- 
tains a large amount of tannic acid, which contracts mucous 
membranes (astringent action). 

Appearance of the Patient 

When a patient is given an average dose of caffeine, or 
when a strong cup of coffee is taken, the following effects 
are noticed: 

The patient is more wakeful, brighter, and is able to think 
more quickly and better, and to reason better. In fact, all 
mental work can be done better and with less fatigue. The 
patient is more active and responds more easily, more rapidly 
and better, to all influences about him. The pulse is quicker 
and may be stronger, and the breathing is deeper and more 
frequent. The patient also urinates more frequently and 
passes more urine. 

292 



BRAIN AND SPINAL CORD STIMULANTS 293 

Caffeine is an ideal stimulant, because it increases the 
activity of almost every organ of the body. Its effects ap- 
pear in about a half to one hour after it is given, and last 
only for one or two hours. 

ACTION 

Caffeine produces no effects when applied locally on either 
the skin or mucous membranes. 

Internal Action 

In the mouth : Caffeine has a slightly bitter taste. 

In the stomach and intestines : Caffeine produces no effects. 
Coffee, however, because of a number of volatile oils which it 
contains, increases the peristalsis, causing mild movements 
of the bowels. 

Action after Absorption 

Caffeine is absorbed into the blood in about a half to one 
hour. It then affects principally the brain, the circulation, 
the respiration, the muscles and the kidneys. The effects 
last for a very short time. 

Action on the Brain: Caffeine increases the action of 
every part of the brain. Impulses reach the brain faster. 
More impulses are sent out from the brain, and these are 
sent out more rapidly. As a result of this action, the patient 
is more wakeful and brighter; he sees and hears better. He 
appreciates influences about him more easily and is able to 
respond to them more readily. He is able to think better, 
easier and faster. He reasons better, his ideas arise more 
readily, he can express them with greater ease, and he can 
remember better. He is more active, more talkative, and 
absolutely rational in everything he says or does. 

These effects result from increased action of the various 
regions of gray matter in the brain. For instance, the 
greater activity of the patient, is due to more impulses being 
sent out from that part of the gray matter of the brain which 
controls motion. The patient is brighter and wakeful 
because he is more susceptible to influences and impressions 
received from his environments. He appreciates the im- 



294 MATERIA MEDICA 

pressions received through his various senses much better; 
and this keeps him wakeful. He reasons better, because 
the impressions which are received in the brain are rapidly 
combined into new ones. The memory is better, because 
impulses are more rapidly sent out from the various areas of 
gray matter of the brain where old impressions had been 
stored up. 

Action on the Spinal Cord: The action of the spinal cord 
is increased by caffeine. As a result, the patient responds 
more quickly and more actively to impressions received 
through his various senses (reflex action) . For instance, the 
muscles contract better because their tone (a state of mild 
maintained contraction) is increased, the bowels move better 
because they respond faster when they become distended; 
The reflex response to impulses such as pain, is increased. 

Action on the Circulation: In the doses that are usually 
given, caffeine has no direct effect on the heart. 

Action on the Blood Vessels: The small blood vessels, 
however, are made narrower by contraction of the muscle 
fibers in their walls as a result of the impulses sent to them 
from the area of gray matter m the medulla which controls 
the caliber of these vessels (vaso constrictor center). As a 
result of this action the pulse becomes somewhat more rapid, 
and perhaps stronger, for a very short time, and there is a 
slight evanescent rise in blood pressure. 

Action on the Kidneys: Caffeine increases the flow of 
urine by directly affecting the cells of the kidneys. It is one 
of the best diuretics. It dilates the blood vessels of the kid- 
ney, thus also improving the circulation of the kidney. 

Excretion 

Caffeine is excreted mainly by the kidneys in a few hours. 
Very little caffeine is excreted as such. Most of it is changed 
to urea, a normal constituent of urine. 

Poisonous Effects 
Acute caffeine poisoning is very rare, because the caffeine 



BRAIN AND SPINAL CORD STIMULANTS 295 

is excreted very rapidly. The following symptoms were 
present in a few cases that have occurred: 

1. Headache. 

2. Confusion. 

3. Noises in the ear. 

4. Flashes of light. 

5. Delirium. 

6. Palpitation of the heart. 

7. Rapid weak pulse. 

8. Short quick breathing. 

9. Con\ailsive movements of the hands and tremors of 
v^arious parts of the body. 

10. Profuse flow of urine. 

11. Collapse (pallor, cold moist skin, rapid thready pulse, 
slow and shallow breathing, cold extremities) . 

Chronic Caffeine Poisoning — 'Toffee Habit" 

This occurs particularly in people who drink strong coffee 
habitually. The patient is very nervous, is easily excited 
and disturbed even by the slightest noise. He is unable to 
sleep, complains of headache, palpitation of the heart and 
twitching of the fingers and hands. The pulse may be 
rapid and irregular. 

When the patient stops drinking coffee, all these s>Tiip- 
toms disappear. 

Administration 

Caffeine is given in capsules, tablets or powders. It 
should be given well diluted in water. Since its effects 
appear rapidly and soon pass off, it is better to give small 
doses, frequently repeated, than a single large dose. ^\Tien 
the effect of one dose wears off, there is more caffeine in the 
body to produce its effects. 

Uses 

Caffeine is one of the best stimulants for collapse. The 
effect is due to the stimulation of the brain, the breathing 
and to the contraction of the blood vessels. It is also an 
excellent diuretic. In heart weakness, in the course of in- 



296 MATERIA MEDICA 

fectious diseases, caffeine is a valuable drug, because of the 
general stimulation of the patient and the contraction of 
the usually dilated blood vessels. 

Preparations 

Caffeine 0.06-0.3 gm. grs. i-v 

(Caffeina) 

Caffeine Citrate 0.06-0.5 gm. grs. i-viii 

(Caffeina Citrata) 

Effervescent Caffeine Citrate 4.0 gms. 5i 

(Caffeina Citrata Effervescens) 

This is a mixture of caffeine citrate, sodium bicarbonate, 
tartaric acid and sugar, containing 4% of caffeine citrate. 
It effervesces when dissolved in water. 

Caffeine Sodium Benzoate 0.06-0.3 gm. grs. i-v 

(Caffeina Sodii Benzoas) 

(Unofficial) 

This is an excellent preparation for hypodermic use. 
It is usually kept in 25% stock solutions. 

Guarana 

Guarana is a paste made from the seeds of PauUinia 
sorbilis, a Brazilian plant. It contains caffeine and tannic 
acid. It is used for sick headache and neuralgia. In Brazil, 
it is also used to check diarrhoea because of the tannic acid 
which it contains. 

Preparations 

Fluidextract of Guarana 2.0 c.c. m. xxx 

(Fluidextractum Guaranae) 

There are numerous preparations of the kola nut on the 
market. Many of them are used as stimulating drinks, 
because of the caffeine v/hich they contain. 

NUX VOMICA AND STRYCHNINE 

Nux vomica is obtained from the seeds of the Strychnos 
nux vomica, and Strychnos ignatia, trees which grow in the 
East Indies. The seeds are round, fiat discs about the size 



BRAIN AND SPINAL CORD STIMULANTS 297 

of a five cent piece, and are often called poison nut, or 
quaker buttons, because they resemble gray buttons. 

The active principles are two alkaloids: strychnine and 
brucine. The effects of both are the same; brucine being 
half as strong as strychnine. Nux vomica also contains an 
acid, igasuric acid. 

The action of nux vomica is due to the strychnine which 
it contains, so that the effects of the drug are the same as 
those of its active principle. 

Appearance of the Patient 

When strychnine or a preparation of nux vomica is given, 
the patient complains of its very bitter taste. The appe- 
tite is increased and digestion is improved. The patient feels 
stronger and more energetic. The pulse is slower and 
stronger, and the breathing is deeper and more rapid. 

All the sensations are better appreciated. The sight and 
hearing are more acute. The sense of touch is more sensitive. 
The body responds more quickly and more vigorously to all 
impressions received through the various senses. These 
effects are usually noticed only after prolonged use. 

ACTION 

Local action: No effects are produced when either nux 
vomica or strychnine are applied to the skin or mucous 
membranes. 

Internal Action 

In the mouth: Strychnine has a very bitter taste. It is 
one of the bitterest substances known; a 1-1,000,000 solution 
gives a bitter taste. Because of the bitter taste, it increases 
the appetite and the flow of saliva. 

In the stomach: Strychnine increases the secretion of 
gastric juice, and the peristalsis of the muscle wall of the 
stomach. The digestion is thus aided, and the food is 
quickly passed on to the intestines. 

In the intestines: It increases the secretion of the mucous 
membranes and the peristalsis. Frequent movements of the 
bowels then result. 



298 MATERIA MEDICA 

The increased peristalsis of the stomach and intestines pro- 
duced by strychnine, is due to its effect on the mucous mem- 
brane of these organs, and to its action on the spinal cord. 
The effect on the mucous membranes sends impulses to the 
spinal cord, which is especially made more active. The 
spinal cord then sends out more and faster impulses to 
contract the muscles of the stomach and intestines. 



Action after Absorption 

Strychnine is absorbed into the blood mainly from the 
intestines, in about one or two hours. After absorption, it 
affects principally the circulation, the respiration, and the 
spinal cord. 

Action on the circulation; On the heart: Strychnine makes 
the heart beat slower, by causing the vagus or inhibitory 
center in the medulla to send more impulses for slowing the 
heart. 

On the blood vessels: It makes the blood vessels narrower; 
especially the small blood vessels in the abdomen. This is 
due to the effect on the vaso-motor center in the medulla, an 
area of gray matter which sends out impulses to control 
the width of the blood vessels. Strychnine makes this center 
more active. More impulses are then sent to the muscle 
fibers in the walls of the blood vessels to make them contract. 
The blood vessels then become narrower, and offer a greater 
resistance to the contractions of the heart, which then beats 
stronger. The blood pressure is also increased by the con- 
traction of the blood vessels. 

The total effect of strychnine on the circulation is there- 
fore to make the heart beat slower and stronger. The char- 
acteristic strychnine pulse is slow and strong. 

Action on the respiration: The breathing is deeper and 
faster because of the increased impulses for breathing sent 
out by the respiratory center in the medulla. 

Action on the nervous system: Strychnine increases the 
appreciation of all the various sensations; thus pain is felt 
more keenly, the senses of smell and taste become more 
acute. The patient is able to see and to hear somewhat 



BRAIN AND SPINAL CORD STIMULANTS 299 

better, and to appreciate various objects better through the 
sense of touch. 

Action on the spinal cord: This is the most important 
action of strychnine. Most of the strychnine effects result 
from its action on the spinal cord and medulla. It enables 
the terminations in the spinal cord of the sensory nerves, 
to transmit their impulses more readily to the cells in the 
gray matter of the spinal cord. These cells then respond 
more readily to any impulse which reaches them along the 
sensory nerves, thus increasing the reflex action. 

As a result of the increased reflex action all the activities 
of the body which are affected by impulses received through 
th'B various sensory nerves, are increased. 

In this way, strychnine acts as a tonic, improving the 
activity of every part of the body. The patient responds 
better and more readily to all the impressions received 
through the various senses. His muscles contract better, 
because they respond more easily and more readily, to im- 
pressions received through the various senses. After con- 
tinued strychnine administration the individual is therefore 
able to do more work. 

The appetite and digestion are better, and the bowels 
move more often, because of the increased reflex action which 
makes the gastric and intestinal muscles respond more easily 
to any substance affecting their mucous membranes. 

The heart beats stronger, and the breathing is more rapid 
and deeper. 

As a result of all these effects on the various organs of the 
body, the patient feels stronger, healthier, and his general 
condition is improved. 

Excretion 

Strychnine is excreted mainly by the kidneys, though very 
slowly. It takes about three to seven days for the drug 
to be entirely eliminated. 

Poisonous Effects 
Strychnine poisoning occurs in two forms : acute poisoning 
and cumulative poisoning. 



800 MATERIA MEDICA 

Acute Strychnine Poisoning 

Acute strychnine poisoning usually results from an over« 
dose of strychnine, or when a preparation of the drug is 
taken with suicidal intent. The sjrmptoms appear very 
soon after it is taken, usually in about fifteen minutes. 

Symptoms 

1. The patient complains first of stiffness of the muscles 
of the neck or face, and of slight stiffness of the jaw; soon 
there follows twitching of the face or arms. 

2. Sudden tetanic convulsions of the whole body then occur. 
The arms and legs are rigid and extended. The head is 
drawn back, and the back is bent so that it forms a con- 
cavity (opisthotonus). The contractions of the facial mus- 
cles draw up the corners of the mouth, causing a peculiar 
grin and ghastly expression known as the ^^risus sardonicus." 

The convulsions are due to the increased refiex action, and 
are brought on by the slightest stimulus; such as a gust of 
air, the touch of a blanket, a flash of light or the slam of a 
door. After the convulsion, all the muscles are relaxed and 
there is a feeling of soreness, but the slightest touch, a gust 
of wind, or a loud noise, at once produces another paroxysm. 

3. The contractions of the muscles of the diaphragm, 
during the convulsions, give the face and lips a blue color, 
from the lack of oxygen in the blood, due to the interference 
with the breathing. 

4. The pulse is slow and stronger, but during the convul- 
sions it is often rapid and weak. 

5. The convulsions become more frequent and often 
clonic in character, and the patient finally dies of asphyxia, 
in about two or three hours, the mind remaining clear to the 
end. 

The symptoms of strychnine poisoning are all due to its 
effect on the spinal cord. In a normal individual, an exter- 
nal stimulus, such as touching the skin, etc., sends an im- 
pulse to the spinal cord which results in the contraction of 
only one, or of a number of muscles; so as to draw the arm 
or leg away from the stimulus. In strychnine poisoning 
afferent impulses are received so readily by the spinal cord, 



BRAIN AND SPINAL CORD STIMULANTS 301 

that even the shghtest stimulus causes a marked response. 
So many unpulses are suddenly sent out from the cord, that 
violent contractions of all the muscles of the body, or con- 
vulsions result. 

Treatment 

L Give tannic acid or tea to combine with the strychnine. 

2. Wash out the stomach or give emetics (but not dur- 
ing the convulsions) if strychnine has been taken by the 
mouth. 

3. If the patient has convulsions, give ether to control 
them, and then wash out the stomach. 

4. To prevent the convulsions from returning, chloral or 
bromides are given repeatedly. 

5. Catheterize; to prevent reabsorption of the strych- 
nine from the urine. 

6. Give artificial respiration and oxygen when the patient 
is blue and cyanotic. 

Cumulative Strychnine Poisoning 

Since strychnine is rapidly absorbed and very slowly 
excreted, some of it always remains in the body when it is 
given continuously, and often causes cumulative symptoms. 
These symptoms, which result from the accumulation of 
strychnine in the body, are the same as the acute symptoms, 
but they develop more slowly. 

Symptoms 

1. The earliest symptoms which indicate that the patient 
is getting too much strychnine, are twitching of the muscles 
of the face or of the extremities, such as shrugging of the 
shoulder or twitching of the fingers. 

2. Often the earliest symptom may be diarrhoea. 

3. Soon the patient complains of stiffness of the neck 
and jaw or in the muscles of the face. 

If the drug is continued, convulsions may occur. 

Treatment 
Stop the drug as soon as the earliest symptoms are 



302 MATERIA MEDICA 

noticed. This enables the strychnine in the body to be 
eliminated, and further symptoms are avoided. If other 
symptoms occur, the treatment is the same as for acute 
poisoning. 

Uses 

Strychnine is used principally for the following effects : 

1. As a heart and respiratory stimulant in collapse. 

2. In various forms of paralysis, to increase the contrac- 
tions of the muscles. 

3. As a tonic, to improve the general health and strength 
of the body. 

4. To increase the appetite and to improve the action of 
the bowels. 

Administration 

For rapid effect in collapse, strychnine should be given 
hypodermically. 

To increase the appetite, nux vomica is usually given, be- 
fore meals undiluted. 

Preparations 
Nux Vomica 

Solid Preparation: 

Extract of Nux Vomica 0.015-0.06 gm. gr. i-i 

(Extractum Nucis Vomicae) 

Fluid Preparations: 

Fluidextract of Nux Vomica 0.06 -0.3 c.c. m. i-v 

(Fluidextractum Nucis Vomicae) 

Tincture of Nux Vomica 0.3 -1.0 c.c. m. v-xv 

(Tinctura Nucis Vomicae) 

This is the preparation most frequently used as a tonic. 



Strychnine 
(Strychnina) 

Strychnine Sulphate 
(Strychninae Sulphas) 



Strychnine 




0.0015-0.004 gm. 


gr. To-r5 


0.0015-0.004 gm. 


gr. 4V-r5 



BRAIN AND SPINAL CORD STIMULANTS 303 

This is the preparation used hypodermically in collapse. 
In hospital practice it comes in a 1% solution or weaker. 

Strychnine Nitrate 0.0015-0.004 gm. gr. ^VtV 

(Strychninae Nitras) 

Non Official Preparations 

Iron and Strychnine Citrate 0.06 -0.2 gm. gr. i-iii 
(Ferri et Strychninae Citras) 

Syrup of Iron, Quinine and Strychnine Phosphate 

4.0 -8.0 c.c. 3i-ii 
(Syrupus Ferri, Quininae et Strychninae Phosphatum) 

This contains /o of a grain of strychnine in each 5i dose. 

Elixir of Iron, Quinine and Strychnine Phosphate 

4.0-8.0 cc. 3i-ii 

(Elixir Ferri, Quininae et Strychninae Phosphatum) 

It contains ^V of a grain of strychnine in each 3i dose. 



PART V. B.— DRUGS WHICH DEPRESS THE CENTRAL 
NERVOUS SYSTEM 

CHAPTER XVII 

BRAIN AND SPINAL CORD DEPRESSANTS 

We may classify the drugs which lessen the action (de- 
press) of the brain in the following groups. (See page 289 
for cerebral depression). 

1. Analgesics 

2. General Cerebral Depressants 

3. Progressive Cerebral Depressants 

4. General Anaesthetics 

5. Hypnotics 

Analgesics are drugs that are used principally to relieve 
pain. Many of the analgesics depress certain functions of 
the brain while stimulating others. 

General Depressants are drugs that lessen the action of 
the entire brain. 

Progressive Depressants are drugs that progressively de- 
press the functions of the brain. They usually depress the 
higher functions such as inhibition first, thus removing the 
restraint from the brain activities and causing a stage of 
excitement. This is followed by progressive depression 
of all the other functions. In poisonous doses they may pro- 
duce unconsciousness. Since the excitement is the most 
apparent symptom, the progressive depressants are often 
called intoxicants. 

General Anaesthetics are drugs that produce unconscious- 
ness and insensibility to pain. They usually progressively 
depress the brain like the Progressive Depressants. The 
excitement stage, however, is of very short duration and is 
soon followed by the stage of unconsciousness which may 
last for a long time and is not accompanied by other poison- 
ous effects. 

304 



BRAIN AND SPINAL CORD DEPRESSANTS 305 

Hypnotics are drugs that lessen the function of the brain 
so as to produce sleep, without causing insensibility to pain. 

In this chapter we shall consider only the analgesics, 
general depressants and progressive depressants. 

ANALGESICS 

Analgesics are drugs which are used principally to relieve 
pain. Pain can be relieved in several ways : 

1. By lessening the activity of the sensory areas of the 
brain so that the impulses of pain which the brain receives, 
are not appreciated. 

2. By lessening the activity of the nerve endings in the 
skin which receive the impulses of pain. 

Drugs which relieve pain are divided into two classes : 

1. Analgesics 

2. Anodynes 

Analgesics are drugs which relieve pain when given inter- 
nally. 

Anodynes are drugs which relieve pain when applied to the 
particular site where the pain is felt. 

The most important analgesic is opium and its principal 
alkaloid, morphine. The anodynes will be considered under 
their appropriate local effects. (See Local Anaesthetics, 
page 433,) 

OPIUM AND MORPHINE 

Opium is the hardened dried juice of the unripe capsules 
of the Papaver somniferum or white poppy, a plant which 
grows principally in Turkey, Asia Minor, Persia, India and 
China. The drug is obtained by making a longitudinal or 
transverse cut in the capsule, when a thick white milky juice 
oozes out. This is exposed to the air, and allowed to dry, 
when it turns brown and hard. This dried juice is the crude 
opium, from which all the preparations are made. It has a 
peculiar characteristic odor. 

Opium is one of the oldest drugs in medicine. It is the 



306 MATERIA MEDICA 

most reliable and most useful drug in the entire Materia 
Medica. It relieves pain better than anything else, no 
matter what the cause of the pain may be. 

Active Principles 

The active principles of opium are the following alkaloids : 

Morphine 

Papaverine 

Codeine 

Narcotine 

Thebaine 

Opium also contains a number of other unimportant sub- 
stances. 

The action of opium is due principally to the morphine 
which it contains, amounting usually to 9% of the drug. 
Morphine affects principally the brain, while the other alka- 
loids in the order given above, do not affect the brain as 
much, and act more upon the medulla and spinal cord. 
Thebaine, the last member of the group, produces effects 
similar to those of str^^chnine, which are due principally to 
the action on the spinal cord. 

Appearance of the Patient 

About ten to fifteen minutes after giving an average dose 
of opium or morphine, the patient complains less of the pain 
from which he may have been suffering. He becomes calm, 
abstracted and quiet, and feels comfortable. "WTien spoken 
to, he may not answer, because of his drowsy, abstracted 
condition. He ma}^ lie in a quiet dreamy state, in which he 
seems to see various objects and persons about him, and 
seems to be in various places. These dreams may be so 
pleasurable, that the patient forgets everything — pain, cares, 
worries. Time passes rapidly on and he lives in a world 
of his own. 

Soon, however, the patient falls into a light sleep from 
which he can be easily aroused. During the sleep, he may 
have vivid dreams, many of which he often remembers 
afterwards. Often the sleep is deeper, resembling the natural 
sleep. 



BRAIN AND SPINAL CORD DEPRESSANTS 307 

The breathing is slow and shallow, the pulse is perhaps 
somewhat slower, the face is flushed, the pupils are con- 
tracted and the skin may be moist. These effects last for 
several hours, and gradually wear off, leaving the patient 
feehng dull and depressed, with dryness of the throat and 
occasionally a slight headache and nausea. 

ACTION 

Local action : Applied to the skin, opium or morphine pro- 
duces no effect. 

Mucous membranes are contracted, and the secretions 
are checked by opium or morphine. It may be shghtly 
absorbed from wounded surfaces and mucous membranes 
when locally applied to them, but whatever effects then 
result are due to absorption. 

Internal Action 

In the mouth : Opium or morphine has no effect. 

In the stomach: It checks the secretion of gastric juice 
and lessens the peristalsis. It also lessens the appetite and 
the feeling of hunger. These effects result from absorption, 
however. Later, however, opium or morphine increases the 
secretions in the stomach and may even cause nausea and 
vomiting. This may be due to the formation of apomor- 
phine in the body which then affects the vomiting center. 

In the intestines : The secretions of the mucous membrane 
and the peristaltic contractions of its muscle wall are mark- 
edly lessened, causing constipation. The effect is due to ab- 
sorption, however. 

Action after Absorption 

Morphine is very rapidly absorbed into the blood through 
the mucous membrane of the stomach, usually in about ten 
or fifteen minutes. It can also be absorbed from all the 
mucous membranes. When given hypodermically, it acts 
in about two to five minutes. Opium preparations are 
absorbed more slowly. After absorption, opium and mor- 
phine affect principally the brain, the respiration, the secre- 
tory glands and the pupil. 



308 ■- MATERIA MEDICA 

Action on the Nervous System 

On the brain : Opium or morphine lessens all the activities 
of the brain except the imagination, which is frequently 
made more active. 

On the sensory areas: It lessens the activities of all the 
sensory areas of the brain. Thus the appreciation of all 
sensory impulses, especially that of pain, is lessened. Since 
consciousness is the result of the sensory impressions received 
through our sensations, by lessening the appreciation of 
the sensations, opium or morphine produces unconsciousness 
or sleep. When the patient is unable to sleep on account of 
pain, these drugs are particularly valuable. The sleep is 
light, however, and the patient may be easily awakened. 
Often it is deeper and resembles the natural sleep. 

On the motor areas : The action of the motor areas of the 
brain is slightly lessened, so that the patient is not quite so 
active. 

On the mental activities: The higher mental activities 
of the brain, such as will power, judgment, reasoning, and 
concentration are all lessened. ; 

The action of the imaginative center of the brain, however, 
is frequently increased. The patient is then able to combine 
old impressions that have been stored up in the brain, more 
readily and more rapidly into new ones. The resulting 
thoughts then flow more freely. The increased activity 
of the imagination is more marked in the more educated, and 
higher intellectual types of individuals or those having a 
vivid imagination. Some very excellent literary works have 
been written while the author was under the influence of 
opium, when his imagination was very active. 

As a result of the greater play of the imagination, vivid 
dreams may occur during the sleep resulting from opium or 
morphine. Even when the patient is awake, but under the 
influence of the drug, he may be absorbed in various thoughts 
and visions which may be conjured up before his mind. 
These produce a feeling of pleasure and comfort, and pre- 
occupy the mind so that he forgets everything — ^pain, wor- 
ries, cares, even the idea of time. It is because of these 



BRAIN AND SPINAL CORD DEPRESSANTS 309 

pleasant effects, that opium tends to form a habit, espe- 
cially after prolonged administration. The opium habitue 
may even have brilliant ideas while under the effect of the 
drug, but because the will power is lessened, he is unable 
to carry these ideas into effect. 

Action on the respiration: Opium or morphine makes the 
breathing slower and shallower by lessening the impulses for 
breathing, sent out from the respiratory center in the medulla. 

Action on the circulation: It produces no effect on the 
heart. 

The blood vessels of the face and neck are dilated, how- 
ever, causing a flushed face and a feeling of warmth. 

The pulse after opium or morphine is usually normal and 
strong. With larger doses, the pulse is somewhat slower. 

This is due to the slow breathing which prevents the blood 
from getting the proper amount of oxygen, and the character 
of the pulse is due to the shght asphyxia which results. 

Action on the secretory glands: Opium or morphine checks 
all the secretions except the sweat, which it increases. 

The flow of sahva, of bile and of the secretions of the mu- 
cous membranes of the stomach and intestines are all les- 
sened. The secretion of urine is often markedly diminished. 

The perspiration is increased more by the preparations 
of opium than by those of morphine. 

Action on the involuntary muscles: The contractions of the 
involuntary muscles are lessened. Intestinal peristalsis is 
thus lessened; which, in addition to the diminished secretion 
of the intestines, causes constipation. 

Action on the pupil: Opium or morphine contracts the 
pupil. It makes the pupil very small when given internally. 
When applied locally to the conjunctiva it produces no 
effects. 

Excretion 

Opium or morphine is rapidly eliminated from the body, 
mainly by the digestive tract, into the stomach, intestines 
and saliva and slightly by the urine, usually in about an 
hour. The drug is frequently absorbed again from the 
stomach and intestines. 



310 MATERIA MEDICA 

Summary of Effects 

The most important effects of opium or morphine are the 
following : 

1. It relieves pain. 

2. It makes the breathing slower. 

3. It lessens all the secretions, except the sweat; which is 
increased. 

4. It checks peristalsis, producing constipation. 

5. It contracts the pupil. 

Idiosyncrasies 

a. Idiosyncrasies of Effect. 

In some individuals, the following unusual effects occasion- 
ally occur: 

1. Weakness and depression. 

2. Continual nausea and vomiting. 

3. Delirium and excitement. (This is especially apt to 
occur in women.) 

4. Convulsions. 

5. Redness of the skin and itching when the effects are 
passing off. 

6. Diminished secretion of urine, especially in cases of 
nephritis. 

b. Idiosyncrasies of Dose. 

In some individuals a very small dose may cause very deep 
sleep, and even poisonous effects. In others, a very large 
dose may cause no effects at all, or only slight effects. Old 
people and children are very susceptible to opium or mor- 
phine. They may get poisonous symptoms from very small 
quantities. 

Poisonous Effects 

Poisoning from opium or morphine occurs in two forms: 
acute opium poisoning and chronic opium poisoning or 
opium habit. 



BRAIN AND SPINAL CORD DEPRESSANTS 311 

Acute Opium Poisoning 

Acute opium poisoning usually results from an overdose 
given medicinally, or when a preparation is taken with 
suicidal intent. Old people or children are very susceptible 
to morphine. 

Symptoms 

Since ihe most striking effect of opium is sleep, the symp- 
toms are divided into three stages, according to whether 
the patient can be aroused from the sleep, whether he can 
be aroused with difficulty (stupor) or whether he cannot be 
aroused at all (coma). 

Symptoms of the First Stage 

1. Slow, shallow breathing. (This frequently occurs from 
an ordinary dose.) 

2. Slow, strong pulse. 

3. Flushed face. 

4. Contracted pupils. 

5. Profuse perspiration. 

6. Sluggish mentality, inattentiveness, perhaps sleep. 

If a very large dose has been taken, these symptoms may 
last for a very short time, or they may be absent entirely, 
and are soon followed by — 

The Second Stage or Stage of Stupor 

1. The sleep is very deep, and the patient can be aroused 
only with great difficulty. If spoken to in a loud voice, or 
when he is shaken and his attention attracted, he may brace 
up for a few minutes; but he soon falls asleep again. 

2. The breathing is very slow and shallow, about 4 to 10 
times a minute, 

3. The pulse is slow and strong. 

4. The pupils are contracted ("pin point pupils" because 
they are very small). 

5. The skin is blue (cyanotic), because the blood does not 
get enough oxygen on account of the slow and shallow 
breathing. 

6. The skin is covered with perspiration. 



312 MATERIA MEDICA 

These symptoms last for a short time, and the patient soon 
passes into — 

The Third Stage or Stage of Coma 

1. The patient now Ues in a very deep sleep, from which he 
cannot be aroused. 

2. The breathing is very slow and shallow, about 3 to 4 
times a minute. It often becomes periodic : a few moments 
of breathing alternating with periods of absent breathing 
(Cheyne Stoke's Respiration). 

3. The pulse is rapid and weak. 

4. The skin is blue (cyanosis). 

5. Pin point pupils. 

The breathing finally becomes still slower, the pupils 
dilate, and the patient dies from paralysis of the respiration, 
though the heart may beat for several minutes afterwards. 

Synopsis of Poisonous Effects 

The following are characteristic symptoms of acute opium 
or morphine poisoniug: 

1. Sleep, stupor, followed by coma. 

2. Slow and shallow breathing. 

3. Slow pulse. 

4. Contracted pupils, ^'pin-point pupils.'^ 

5. Cyanosis. 

6. Profuse perspiration. 

Treatment 

1. Wash out the stomach, with plain water, or better still, 
with a 1-2000 potassium permanganate solution, which 
makes the drug inactive. The washing should be repeated 
every half hour until the patient is entirely out of danger. 
Even if the drug is given hypodermically, the stomach should 
be washed out, as the drug is excreted into the stomach, and 
repeated washings help to eliminate it. 

2. If the stomach cannot be washed out, for lack of ap- 
paratus, etc., or if a solid preparation has been taken, 
emetics should be given repeatedly, about every 15 minutes. 



BRAIN AND SPINAL CORD DEPRESSANTS 313 

A tablespoonful of mustard in a glass of water, zinc sul- 
phate 0.6-2.0 gms. (grs. x-xxx), copper sulphate 0.3-0.6 gm. 
(grs. v-x) may be given to produce vomiting, and potassium 
permanganate to destroy the drug. 

3. Atropine, gr. x^o, is given. This is the antidote for mor- 
phine. It should be repeated every hour until the breathing 
becomes deep and rapid again. It should never be given 
without the doctor's orders, however, as atropine poisoning 
may result from its injudicious use. 

4. Apply cold douches on the skin, rub or strike the patient 
with wet towels. This keeps him awake and increases the 
breathing. Care must be taken, however, not to cause ex- 
haustion by too violent measures. 

5. Keep the patient warm. 

6. Catheterize. 

7. Keep up artificial respiration continuously. 

8. Respiratory stimulants, such as caffeine, or a hot 
coffee enema, strychnine, etc., are given and should be fre- 
quently repeated. 

9. The application of the faradic current to the Vagus 
nerve in the neck may help the respiration in some 
cases. 

Artificial respiration may be given by means of a specially 
constructed apparatus used for giving anaesthesia. (Meltzer 
Auer method.) By this method air is pumped into the 
lungs through a catheter inserted into the larynx. 

The treatment of opium poisoning should be kept up for 
hours, as long as the patient is alive. Patients have recov- 
ered from as much as 2.0 gms. (grs. xxx) of morphine, by 
persistent treatment. 

Chronic Opium Poisoning or Opium Habit 

The opium habit occasionally results in patients to whom 
it has been necessary to give opium or morphine for a long 
time. The pleasant effects of the drug and the ease with 
which it relieves pain and suffering often induce the habit. 
The drug is usually taken in the form of opium pills or lau- 
danum. Hypodermic injections of morphine is one of the 



314 MATERIA MEDICA 

commonest ways in which the drug is taken. In China 
and India, the crude opium is smoked by many people. 
Opium habitues may take as much as 300 grs. of opium 
without causing dangerous symptoms. 

The largest dose which a habitue can absorb is si- If he 
takes more than that the excess is usually eliminated. 

Symptoms 

The characteristic symptom is the great craving for the 
drug. The other symptoms vary according to whether 
the patient is without his drug or under the influence of his 
usual dose. 

When the habitue is not under the influence of the drug he 
usually has profuse sweating followed by abdominal cramps, 
twitching of the muscles and uncontrollable yawning. He is 
irritable and nervous. He is unable to do his work because 
he cannot concentrate his mind on anything. 

When he gets his usual dose these symptoms disappear; 
he braces up, becomes energetic and is able to work, and 
he then feels quite comfortable. Many habitues have no 
other effects. Usually, however, the devotee passes into 
a drowsy, dreamy state during which he has so much pleas- 
ure that he forgets — his physical pains, his cares, his worries, 
even his responsibilities. He lives in a world of his own, 
where all sorts of pleasurable incidents occur. He may 
get brilliant ideas but is powerless to carry them into effect. 
Many lie in this state for hours and fall into collapse when 
they attempt to get up. Finally, the habitue falls into a 
deep sleep lasting for several hours, and gradually awakes 
with headache, nausea and weakness. 

Prolonged use, however, ultimately undermines both body 
and mind. The individual becomes thin and anaemic. He 
has a loss of appetite and various other digestive disturb- 
ances. He is usually very constipated although he may have 
attacks of profuse diarrhoea. He becomes dull and listless, 
with no self control, no ambition and with no sense of truth 
or honor. Morphine habitues are most inveterate liars and 
cannot be trusted. Many of them develop all sorts of de- 



BRAIN AND SPINAL CORD DEPRESSANTS 315 

praved moral tendencies and others become maniacal or 
insane. 

They usually have a regular pulse, contracted pupils and 
irregular temperature. The arms may be full of needle 
marks and occasionally an abscess develops from the use of 
unsterilized needles. 

The habit is treated by gradually withdrawing the drug, 
the administration of drastic cathartics, and hyoscine as 
an antidote. Stopping the drug suddenly may cause col- 
lapse. 

What Can the Nurse Do to Prevent the Habit? 

There is no condition more pernicious than the opium 
habit, because the habitue becomes a useless member of 
society. The frequency of the habit is indeed surprising. It 
is claimed that in New York City, in spite of the present 
stringent legislation, there are about 100,000 habitues. The 
administration of morphine for the relief of pain may be 
the beginning of a condition that may ultimately lead into 
a most deplorable abyss. 

The nurse should bear these facts in mind, therefore, in 
administering morphine or opium. Whenever the use of 
these substances is indicated, she should use them only after 
exhausting every art of her profession to relieve the pain or 
discomfort. If these measures are of no avail she may give 
the dose ordered; but the patient should on no account be 
informed of the nature of the medicine. 

In incurable cases accompanied by severe pain and in 
recurring cancers we must resort to the use of morphine, but 
this should be done very gradually, lest the time be reached 
too soon, when even morphine is of no avail. 

Uses 

Opium or morphine is used for a great many conditions. 
In fact, there is hardly a condition or disease in which this 
drug is not useful. It is used principally : 

1. To relieve pain. For this purpose it is the best and 
most reliable drug. 



316 MATERIA MEDICA 

2. To produce sleep, especially when the patient is unable 
to sleep on account of pain. 

3. xo lessen peristalsis and produce constipation. 
^. To check the secretions, except the sweat. 

5. To lessen all forms of nervous excitement, such as 
delirium tremens, convulsions, tetanus, etc. 

Administration 

For rapid effects, morphine, given hypodermically, is 
the best preparation to use. Opium is better where con- 
stipation is desired. 

Preparations 

Opium 

Solid Preparations 

Powdered Opium 0.03-0.12 gm. grs. i-ii 

(Opii Pulvis) 

This contains 12% of morphine. 

Deodorized Opium 0.03-0.12 gm. grs. |-ii 

(Opii Deodoratum) 

This contains 12% of morphine, but its odorous substances 
have been removed. 

Pills of Opium 1 pill 

(Pilulae Opii) 

Each pill contains 0.06 gm. (gr. i) of powdered opium. 
These pills must be freshly made, as otherwise they accumu- 
late in the stomach and cause poisonous effects. 

Extract of Opium 0.015-0.06 gm. gr. i-i 

(Extr actum Opii) 

This contains 20% of morphine. 

Powder of Ipecac and Opium 0.6 gm. grs. x 

(Pulvis Ipecacuanhae et Opii) 
(Dover's powder) 

Each powder contains 0.06 gm. (gr. i) each of ipecac 
and opium, and 0. 5 gm. (grs. Yiii) of milk sugar (it contains 
10% of opium). Dover's powder is taken at night in hot 



BRAIN AND SPINAL CORD DEPRESSANTS 317 

lemonade; to break up a cold. It increases the perspiratioc 

very freely. 

Troches of Licorice and Opium 

(Trochisci Glycyrrhizae et Opii) 

(Wistar's cough lozenges) 

Each lozenge contains gr. J of opium. It is used to lessen 
cough. 

For Local Use 
Opium Plaster 
(Emplastrum Opii) 

This contains 6% of opium. 
Pantopon 0.005-0.02 gm. gr. i-J 

This is a mixture of the hydrochloride salts of all the 
alkaloids of opium. 

Liquid Preparations 
Tincture of Opium 0.3-1.0 c.c. m. v-xv 

(Tinctura Opii) 
(Laudanum) 

This contains 10% of opium. 
Tincture of Deodorized Opium 0.3-1.0 c.c. m. v-xv 

(Tinctura Opii Deodorata) 

(McMunn's elixir) 

This contains 10% of opium. It contains no narcotine, and 
no odorous principles, and is therefore more pleasant to take. 

Camphorated Tincture of Opium 
(Tinctura Opii Camphorata) 

(Paregoric) 

For Adults 4.0-16.0 c.c. 3i-iv 
For Children 
Under 1 year 0.06-0.3 c.c. 

2 years 0.3 -1.0 c.c. 

3 " 0.3 -1.3 c.c. 
5 " 0.3 -1.6 c.c. 

" 10 " 1.0 -2.0 c.c. 
Paregoric contains 0.12 gm. (grs. ii) of opium to 30.0 gms. 
or (si), together with camphor, benzoic acid, oil of anise 
and glycerine. It is the best preparation of opium to use 
for children. 



m 


i-v 


m. 


v-xv 


m. 


v-xx 


m. 


v-xxv 


m. 


xv-xxx 



318 MATERIA MEDICA 

Tincture of Ipecac and Opium 0.3-1.0 c.c. m. v-xv 
(Tinctura Ipecacuanhae et Opii) 
(Tincture of Dover's powder) 

This contains 10% of opium. 

Wine of Opium 0.3-1.0 c.c. m. v-xv 

(Vinum Opii) 

This is flavored with cinnamon and cloves. 

Acetum Opii 0.3-1.0 c.c. m. v-xv 

(Black drop) 

This is opium extract with dilute acetic acid. 

Mistura Glycyrrhizae Com- 
posita 15.0-30.0 c.c. 5 f-i 

(Brown's mixture) 

This contains 1 part of opium in 1000 of the mixture. 
It consists of paregoric, licorice, wine of antimony, and 
spirits of nitrous ether. It is used to lessen cough. 

Compound Tincture of Opium 4.0 c.c. 5 i 

(Tinctura Opii Composita) 

(Squibb's diarrhoea mixture) 

This contains tincture of opium, tincture of capsicum, 
spirits of camphor, chloroform and alcohol. 

ALKALOIDS OF OPIUM 

Morphine 

The effects of opium are due principally to the morphine 
which it contains. 

The effects of morphine differ slightly from those of opium 
in the following ways : 

1. Morphine is much more rapidly absorbed, and therefore 
acts more rapidly. 

2. It can be given hypodermically. 

' 3. It does not increase the secretion of sweat as much as 
opium. 
4. It is not as constipating as opium. 

Preparations 
Morphine 0.008-0.03 gm. gr. J-i 

(Morphina) 



BRAIN AND SPINAL CORD DEPRESSANTS 31Q 

Morphine Sulphate 0.008-0.03 gm. gr. f-f 

(Morphinae Sulphas) 

Morphine Hydrochloride 0.008-0.03 gm. gr. J-J 

(Morphinae Hydrochloridum) 

Compound Morphine Powder 0.3 -1.0 gm. grs. v-xv 
(Pulvis Morphinae Compositus) 

(Tally's powder) 

This contains morphine sulphate, licorice powder, and 
camphor. 

Magendie's solution of morphine (not official). 

This is a 1 to 30 solution of morphine sulphate (or grs. 
xvi to the ounce) . This is a solution which is very commonly 
used for hypodermic administration. It should always be 
fresh^ as a fungus often grows in old solutions, and makes it 
unfit for use, or it may change the morphine to apomorphine. 

Morphine Meconate 0.008-0.03 gm. gr. |-J 

(Morphinae Meconas) 

Codeine 

Codeine, one of the active alkaloids of opium, is a com- 
pound of morphine (methylmorphine) . Its effects are simi- 
lar to those of morphine, with the following differences: 

1. It does not produce sleep as readily as morphine, and 
the sleep is very light. 

2. It does not slow the breathing as much as morphine; 
and is therefore safer. 

3. It does not produce constipation. 

4. It is not so apt to induce the habit. 

Preparations 

Codeine 0.015-0.06 gm. gr. H 

(Codeina) 

Codeine Sulphate 0.015-0.06 gm. gr. J-i 

(Codeina Sulphas) 

Codeine Phosphate 0.015-0.06 gm. gr. J-i 

(Codeina Phosphas) 

Eucodin 0.06 gm. gr. i 

(Methyl Codeine Bromide) 



320 MATERIA MEDICA 

This is used like codeine, to lessen coughing, but it is 
said to increase the secretion of mucus. 

Narcotine causes muscular twitchings, and thebaine acts 
like strychnine, causing convulsions. Both of these alka- 
loids are not used in medicine. 

Artificial Alkaloids of Morphine 

The following alkaloids are made artificially, by the action 
of various chemical substances on morphine. 

Dionine 

Dionine is an artificial alkaloid made from morphine 
(ethyl morphine) . 

Its effects are similar to those of codeine. It is safer than 
morphine. It is used to produce sleep and relieve pain. It 
does not contract the pupil. 

Preparations 

Dionine 0.015-0.06 gm. gr. J-i 

(Dionina) 

Peronine 

Peronine is a substance which has the same effects as 
dionine. It is given in the same doses. 

Heroin 

Heroin is an artificial alkaloid made from morphine by 
its combination with an organic salt of acetic acid (diacetyl 
morphine hydrochloride) . Its effects are similar to those of 
morphine with the following differences : 

1. It makes the breathmg slower than morphine does. 

2. It is used principally to lessen coughing. It does not 
produce sleep as easily. 

Recently the heroin habit has become very common, 
because of the difficulty in obtaining morphine. The heroin 
is usually taken by snuffing heroin powder up into the nose. 
The symptoms are like those of the morphine habit. 



BRAIN AND SPINAL CORD DEPRESSANTS 321 

Preparations 

Heroin 0.0025-0.01 gm. gr. aVe 

(Heroina) 

Heroin Hydrochloride 0.0025-0.01 gm. gr. 2^-^ 

(Heroinae Hydrochloridum) 

CANNABIS INDICA (INDIAN HEMP) 

Cannabis indica is a resinous substance obtained from 
the flowers of the Cannabis sativa or Indian hemp, a plant 
growing in India, Egypt, and the southern part of the United 
States. 

It is used as an intoxicant in various forms in most of the 
Eastern countries. In India, the dried plant is used for smok- 
ing, either alone or with tobacco, and is called gunjah or 
bhang. Churrhus or hashish is an intoxicating drink con- 
taining the resinous juice, which is used in Arabia and Egypt. 
The resinous substance is often flavored with sugar or 
honey, and made into a confection. The active principle of 
cannabis indica is said to be a red oil or resin called canna- 
binol. 

Appearance of the Patient 

About a half to one hour after giving an average dose of a 
reliable preparation of cannabis indica, the patient feels 
drowsy, the sense of pain is lessened, the extremities feel 
numb, the patient often complains of noises in the ear, and 
he soon falls into a deep sleep, lasting several hours, from 
which he usually awakes refreshed. During the sleep, he 
may have particularly vivid beautiful dreams. The pulse 
and breathing are normal and the pupils are dilated. Oc- 
casionally he may be somewhat exhilarated before falling 
asleep. 

ACTION 

Cannabis indica produces no local effects. 

Internal Action 

When given internally it has a peculiar taste. It produces 
no effect in the stomach and the intestines, but is rapidly 



322 MATERIA MEDICA 

absorbed into the blood; from the stomach, and it then acts 
principally on the brain. 

Action on the brain : Cannabis indica lessens the apprecia- 
tion of the various sensations, such as pain, touch, etc. In 
this way, it relieves pain and produces sleep. 

It lessens the higher intellectual functions such as reason- 
ing and judgment and also the sensory areas of the brain, 
while increasing the imagination. This accounts for the re- 
lief from pain and the characteristic vivid dreams. It dilates 
the pupil. 

Effects of Large Doses 

When cannabis indica is taken in large doses, or when it is 
smoked, it usually produces a characteristic state of pleasure 
and exhilaration which accounts for its frequent use as an 
intoxicant. 

Very soon after taking a large amount of hashish, the 
individual passes into a drowsy state, during which he has 
the most beautiful dreams, and forgets everything — cares, 
worries, troubles, events which occur about him, even the 
individuals about him. He has visions of the most gor- 
geously beautiful scenes, amidst which he imagines all 
sorts of romantic incidents. He is usually joyful and happy, 
and seems to be in a garden of paradise far more beautiful 
than every previous conception of it. 

These dreams are more marked in the languid oriental 
people. Europeans or Americans, unless they are partic- 
ularly emotional, usually do not have such extravagant 
dreams, but merely become joyful and happy. 

During this state of exhilaration, ideas arise so rapidly, 
that time seems to pass much faster than it actually does. 
Events which usually last hours seem to occur in several 
minutes. This state of exhilaration lasts for a short time, 
perhaps an hour, and the patient then falls into a normal, 
quiet sleep from which he can be readily awakened. Often 
the individual has a sense of impending death. Occasion- 
ally it causes a feeling of a dual personahty; that is, the 
devotee feels as if he were two different persons at the 
same time. 



BRAIN AND SPINAL CORD DEPRESSANTS 323 

The pulse is perhaps a Utile stronger and faster, the breath- 
ing is normal, and the pupils are dilated. 

In India, the natives often produce a state of catalepsy 
(stiffening of all the muscles) by means of hashish. 

Uses 

Cannabis indica is used to relieve pain and to produce 
sleep as a substitute for morphine, in neuralgia, painful 
menstruation, chorea, hysteria, etc. It is an unreliable 
drug, however, as many of its preparations are inactive. 
Preparations made from plants grown in warm climates are 
usually better. 

Preparations 

Extract of Cannabis Indica 0.015-0.06 gm. gr.J-i 

(Extractum Cannabis Indicae) 

Fluidextract of Cannabis Indica 0.1 -0.3 c.c. m. i|^-v 
(Fluidextractum Cannabis Indicae) 

Tincture of Cannabis Indica 1.0 -2.0 c.c. m. xv-xxx 
(Tinctura Cannabis Indicae) 

Lactucarium 

Lactucarium is the dried, milky juice obtained from the 
Lactuca virosa, or garden lettuce. It is occasionally used as 
a substitute for opium, to relieve pain and produce sleep. 
It is given in the form of a tincture, in doses of 0.6-4.0 gms. 
(m. x-5i) or as a syrup. 

Other Analgesics 

The coal tar drugs or the Analgesic Antipyretics are used 
principally for the relief of nervousness and headache but 
they also slightly relieve pain. They were originally used to 
reduce temperature. The following are the coal tar sub= 
stances most commonly used : 

Antipyrine 

Acetanilid 

Phenacetine 

Pyramidon 

Aspirin 



324 MATERIA MEDICA 

There are several other drugs which contain alkaloids which 
act like morphine in very small amounts. The following 
are the most common substances used : 

Sanguinaria Canadensis or Blood Root 
Chelidonium Majus or Celandine 



GENERAL CEREBRAL DEPRESSANTS 

THE BROMIDES 

The bromides are crystalline salts formed by the combina- 
tion of an alkali, such as potassium, sodium, ammonium, 
etc., with hydrobromic acid. This is an acid formed from 
bromine, an element found in sea water. 

(Every salt consists of two parts: the part derived from 
the alkali, which is called the base; and the part derived 
from the acid, which is called the acid radicle. For example, 
in potassium bromide, the potassium is the base, and is 
derived from the alkali. The bromide is the acid radicle 
and is derived from the acid. Every salt when in solution 
is decomposed into two or more electrical, readily absorbable 
elements, or ions, as they are called. Each of these ions 
produces separate and different effects.) 

The effects of the bromide are due principally to the acid 
radicle, or bromide ion. The base of the salt also produces 
some effects. Each of the various bromides, therefore, pro- 
duces a somewhat different effect because of the different 
base with which it is combined. 

Potassium bromide is a salt formed by the combination 
of potassium, and hj'^drobromic acid, or by some of their 
salts. It is the most active salt of the bromides, and is the 
preparation commonly used. 

ACTION OF THE BROMIDES 

Appearance of the Patient 

About 15 to 20 minutes after an average dose of one of the 
bromides is taken, the patient complains of a dull headache, 
he feels tired and weak, and does not care to exert him- 



BRAIN AND SPINAL CORD DEPRESSANTS 325 

self, either mentally or physically. When he moves about, 
the movements are slow and languid. He perceives objects 
about him, though not as clearly as usual, but he manifests 
no interest in them. He speaks slowly and hesitatingly, in a 
monotonous tone of voice. He does not express his thoughts 
clearly; these are slow and confused, and his reasoning and 
memory are poor. Very often the patient becomes drowsy. 
The pulse is somewhat slower and weaker, and the breathing 
is somewhat slower. 

If the patient is nervous and excitable, he becomes calm 
and quiet. If he has tremors or convulsions, these are les- 
sened or prevented from recurring. 

ACTION 

Local action: Applied to the skin, the bromides produce 
no effects. Mucous membranes, however, are made some- 
what less sensitive. 

Internal Action 

In the mouth: The bromides have a salty taste and they 
make the throat less sensitive, so that when it is touched, 
vomiting is not so apt to occur. 

In the stomach and intestines: No effect is produced ex- 
cept occasional nausea. 

Action after Absorption 

The bromides are absorbed through the mucous mem- 
brane of the stomach and intestines, usually in a few minutes. 
They are also readily absorbed from all mucous membranes. 
After absorption, they affect principally the nervous system. 

Action on the nervous system: The bromides lessen the 
activity of the entire nervous system: the brain, the spinal 
cord and the nerves. 

Action on the brain: The activity of the motor areas of the 
brain is lessened, so that they send out fewer impulses for 
motion. The patient then moves about slowly and lan- 
guidly; he does not care to exert himself. Twitchings of 
the muscles and muscular contractions are lessened. 



326 MATERIA MEDICA 

The activity of the speech area of the brain is lessened. 

The impulses for speech are then sent out more slowly. This 
makes the speech slow, hesitating, often indistinct and its 
tone monotonous. 

The sensory areas of the brain are made less active. The 
patient then sees, hears, and feels objects less distinctly, and 
the appreciation of pain is lessened. The impressions re- 
ceived by the brain through these various senses, are there- 
fore not very vivid. The patient does not manifest much 
interest in the objects or activities about him. Since the 
sensory impressions are less readily received by the brain, 
consciousness is lessened, and the patient becomes drowsy, 
or even falls asleep. 

The mental activities of the brain are lessened, the mem- 
ory is indistinct, and the reasoning is poor. Ideas do not 
arise easily. AH the emotions are especially lessened; so 
that a nervous, hysterical, emotional individual, often be- 
comes calm and quiet. This helps to produce sleep in such 
individuals, who often suffer from sleeplessness because of 
their nervousness. 

The headache which is often produced by bromides, is 
due to the strain that ordinary activities of the brain pro- 
duce in patients under the influence of these drugs. 

Action on the spinal cord : The bromides lessen the activity 
of the spinal cord. The reflex action of the body is therefore 
lessened. The patient does not then respond readily to 
external stimuli applied to the skin or mucous membranes. 
For example, when the conjunctiva of the eye is touched, 
winking results very slowly. When the pharynx is touched, 
vomiting is not produced so easily. The bromides also 
lessen the sexual reflexes. 

Action on the nerve endings: The bromides make the 
sensory nerve endings less sensitive. The patient does not 
then appreciate the various sensations clearly. 

All the foregoing effects on the nervous system, are due 
to the bromide part of the salt, and result from any bromide 
salt, such as sodium, potassium, etc. 

Action on the heart: The bromides makes the heart beat 
slower and weaker, especially when it is overacting, causing 



BRAIN AND SPINAL CORD DEPRESSANTS 327 

a slow, weak pulse. This effect occurs principally from 
potassium bromide and is due largely to the potassium or 
basic part of the salt. The other bromides do not affect 
the heart as much. 

Action on the respiration : In ordinary doses the bromides 
may lessen coughing. Large doses make the breathing slow 
and shallow. 

Effect on temperature: Owing to the lessened activity of 
the various organs of the body, the temperature is slightly 
lowered, because less heat is produced. 

Excretion 

The bromides are very slowly eliminated from the body, 
mainly by the kidneys, the skin (through the sweat glands), 
and by all the mucous membranes. It usually takes about 
24 to 72 hours for the bromides to be entirely excreted, often 
even weeks and months. 

Poisonous Effects 

Acute poisoning from the bromides does not occur. Since 
they are rapidly absorbed, but very slowly excreted, when 
administered continually for a long time the bromides may 
accumulate in the body, and cause cumulative symptoms, 



Symptoms of '^Bromism'^ 

The symptoms may appear gradually or suddenly. They 
are due principally to the exaggerated effects of the bromides, 
and to the effects on the various tissues and organs through 
which they are excreted. For example, the rashes which 
occur, are due to the excretion of the drug through the 
skin. 

1. Skin eruptions. These consist principally of groups of 
pimples on the face (acne); frequently small abscesses 
form in the skin. At other times, there are reddish spots 
scattered over the skin, and the skin may be very pale. 

2. Loss of appetite, salty taste in the mouth, bad breath, 
and disturbed digestion. 



328 MATERIA MEDICA 

3. Constipation. 

4. Drowsiness. 

5. Stupid, dull expression on the face. 

6. Depressed spirits, even melancholia. 

7. The eyes look heavy and dull. 

8. The patient manifests no interest in his surroundings. 

9. Slow, uncertain gait. 

10. Slow, stammering speech, often words are forgotten 
and mispronounced. 

11. Very poor memory, even recent events are forgotten. 

12. Slow pulse. 

13. Lessened reflexes (touching the conjunctiva of the 
eye does not cause winking, etc.). 

Treatment 

When the bromides are stopped, the symptoms gradu- 
ally disappear. Giving cathartics and hot baths helps to 
eliminate the drug more easily. 



Comparative Action of Bromides 

Potassium bromide is the most active salt, but in large 
doses it may weaken the heart action and cause a slow weak 
pulse. 

Ammonium bromide may make the pulse and breathing 
faster. 

Lithium bromide is apt to upset the stomach. It is said to 
increase the flow of urine. 

Uses 

The bromides are used to lessen overactivity of the brain 
m the following conditions : 

1. To prevent epileptic convulsions. 

2. To relieve the muscular twitchings of chorea (''St. 
Vitus' dance")- 

3. To relieve emotional conditions, nervousness or ex- 
citability; in neurasthenia. 



BRAIN AND SPINAL CORD DEPRESSANTS 329 

4. To produce sleep when the insomnia is due to nervous- 
ness. 

5. To lessen sexual excitement. 

Preparations 
Potassium Bromide 1.0-4.0 gms. grs. xv -5i 

(Potassii Bromidum) 

Sodium Bromide 1.0-4.0 gms. grs. xv -5i 

(Sodii Bromidum) 

Ammonium Bromide 1.0-2.0 gms. grs. xv -xxx 

(Ammonii Bromidum) 

Lithium Bromide 1.0-2.0 gms. grs. xv -xxx 

(Lithii Bromidum) 

Strontium Bromide 2.0-4.0 gms. grs. xxx-5i 

(Strontii Bromidum) 

Calcium Bromide 2.0-^.0 gms. grs. xxx-5i 

(Calcii Bromidum) 

Dilute Hydrobromic Acid 2.0-12.0 gms. grs, xxx-3iii 

(Acidum Hydrobromicum Dilutum) 

This is a 10% solution of hydrobromic acid. About 7.0 
c.c. of this solution is equal to 1.0 gm. of potassium bromide. 

Monobromated Camphor 0.3-0.6 gm. grs. v-x 

(Camphora Monobromata) 

This preparation is used to lessen the excitement of hys- 
teria, neurasthenia and sexual excitement. Its effect is 
due mainly to the camphor. 

New and Non-official Preparations 
Adalin 0.3-0.6 gm. grs. v-x 

This is an organic bromide salt (brom diethyl acetylcar- 
bamide) . It produces the same effects as the other bromides. 
Brometone 0.3 gm. grs. v 

This is an organic bromide salt (acetone bromoform), 
which is said not to cause cumulative symptoms. 

Bromipin or Bromiol 1.3-10.0 gms. grs. xx-cl 

This is a combination of bromine and sesame oiL It 



330 MATERIA MEDICA 

usually comes either in a 10 or 331% solution. It is claimed 
that it will not cause cumulative symptoms. It is given 
in syrup flavored with peppermint water. 
Bromo Mangan 4.0-16.0 c.c. 5 i-iv 

This is a compound of iron, manganese, bromine and pep- 
tones. It contains about 11% of bromine. It is used to 
soothe nervousness and to build up nervous patients. 

Brovalol 0.25-0.75 gm. grs. iv-xii 

This is a compound of a valeric acid salt and bromine. 
It is used to soothe nervous patients, and is said to be more 
effectual than either the valerian preparations or the bro- 
mides alone. 

Sabromin 0.5-4.0 gms. grs. viii-5i 

This is an organic salt formed by the combination of 
calcium and dibrombehenic acid. It produces the same 
effects as the other bromides, but they come on slower and 
last longer. It is said to have a more pleasant taste and 
not to upset the stomach. It usually comes in tablets, each 
containing 0.5 gm. (grs. viii). 

The following preparations of the bromides are occa- 
sionally used: 

Bromocoll 2.0-4.0 gms. 5i-i 

This contains about 20% of bromine, gelatin and tannic 
acid. 

Bromidia 

This contains potassium bromide, chloral hydrate, extract 
of hyoscyamus, extract of cannabis indica, hcorice and oil 
of orange peel. 

PROGRESSIVE CEREBRAL DEPRESSANT 
ALCOHOL (ALCOHOL ETHYLICUM) 

Alcohol is a colorless fluid which evaporates very quickly. 
It has a pungent odor, and a burning taste. It burns very 
easily with a blue flame, and it is often used for heating 
purposes. 

Alcohol is formed by the growth of the yeast plant, 



BRAIN AND SPINAL CORD DEPRESSANTS 331 

(a vegetable organism) in a solution of fruits or vege- 
tables containing sugar. This process is called fermentation. 
Starchy fruits or vegetables also produce alcohol on fermen- 
tation, because the starch is changed to sugar, which is then 
fermented by the yeast. The growth of the yeast plant 
changes the sugar to alcohol and carbon dioxide. 

Some alcoholic preparations are made by distillation. The 
fermented fruit, rye or corn is heated in a large vat. Since 
the alcohol evaporates very easily, it turns to vapor when it 
is heated. The vapor then passes along a series of tubes 
into a cool receptacle, where the vaporized alcohol again 
becomes fluid. Distilled liquors are made in this way. 

Appearance of the Patient 

After an ordinary dose of any alcoholic liquor, such as 
whiskey or wine, the patient usually becomes cheerful, is 
satisfied with himself, his surroundings, and those about 
him. He is perhaps more active and more talkative. The 
face is flushed, the eyes are bright and there is a feeling of 
warmth. The pulse is rapid and bounding and the breathing 
is deeper. 

ACTION 

Local action: Applied to the skin, alcohol causes redness 
and itching. It hardens the skin, checks the sweat and acts 
as an antiseptic. Because it evaporates quickly, it makes 
the skin feel cold. If its evaporation is prevented, however, 
or if the skin surface is injured, it becomes red, painful and 
swollen (irritation). 

On mucous membranes : It causes a burning sensation and 
contracts the cells of the mucous membrane. 

Internal Action 

In the mouth : Alcohol has a burning taste, it increases the 
flow of saliva, reddens and contracts the lining membrane of 
the mouth. Strong i)reparations, such as whiskey, often 
cause a burning sensation in the throat; and, on account of 
the fumes which it produces, they cause a fit of coughing, 
and a flow of tears from the eyes and nose. 

In the stomach : Small quantities of weak alcoholic drinks, 



S32 MATERIA MEDICA 

such as beers or wines, aid the appetite, increase the secre- 
tion of gastric juice, and the peristaltic contractions of 
the stomach. 

In the intestines: By the time alcohoHc drinks reach the 
intestines they are so weak that they do not cause any effects. 
In excessive doses they may cause mild bowel movements. 
Some preparations, such as brandy, check diarrhoea. 

Action after Absorption 

Alcohol is very rapidly absorbed, usually in about fifteen 
minutes. Most of the alcohol enters the blood through the 
lining membrane of the stomach, but a small part passes 
through the mucous membrane of the intestines. 

After absorption alcohol affects principally the circulation, 
the respiration, and the brain. 

Action on the Circulation 

The effects of alcohol on the circulation are reflex and 
direct. The reflex effects occur from the local action on the 
mucous membranes and appear before the alcohol is ab- 
sorbed. The direct effects occur after absorption. 

Immediate reflex effects: Almost immediately, but eva- 
nescently, after taking or injecting alcohol the heart beats 
faster and somewhat stronger, causing a rapid bounding 
pulse with an increase in blood pressure. At the same time 
the skin becomes flushed by dilatation of its blood vessels. 

These effects are the result of the local redness and slight 
swelling (irritation) in the mouth or at the site of injection, 
which cause impulses to be sent to the medulla of the brain. 
The medulla responds to these impulses by sending other 
impulses to the heart to make it beat faster and stronger, and 
to the blood vessels to make them dilate. 

Effects after absorption. After absorption alcohol makes 
the heart beat slightly stronger and faster. It increases the 
contractions of the heart muscle and lessens the impulses 
sent from the medulla to slow the heart. 

In large doses it lessens the contractions of the heart mus- 
cle. 

In weakened conditions alcohol may act as a food, supply- 



BRAIN AND SPINAL CORD DEPRESSANTS 333 

ing the heart with energy and thus increasing its muscular 
contractions. 

Action on the respiration: Alcohol makes the breathing 
deeper and more rapid. 

Action on the Nervous System : Alcohol progressively lessens 
the action of the brain. It begins by affecting the highest 
intellectual activities, such as will power, judgment, reason- 
ing. It then affects the motor and sensory functions. Finally 
it lessens the action of the entire brain and of the medulla 
as well. 

The effects on the brain are usually noticed only after tak- 
ing large quantities of alcoholic drinks. The individual be- 
comes self confident of both his physical and mental powers, 
often over confident. He becomes more active and moves 
about energetically. He is more talkative, but his speech is 
not as careful as usual. His ideas are not as clear nor as logi- 
cal and his choice of words and sentences may be poor. He is 
usually more coarsely emotional; he becomes quite jolly and 
he may laugh or cry. 

From larger quantities, the lessened brain action becomes 
progressive and more apparent. The movements become 
incoordinated and staggering. He forgets or repeats words 
and sentences. Finally his movements cease, and stupor 
and coma soon follow. 

Although the symptoms that result from large doses of 
alcohol are apparently those of increased brain activity; 
and this is the view held by some, the general consensus 
of opinion, based on actual psychological experiments is 
that they result from lessened brain activity. 

The normal civilized individual is under constant restraint, 
his thoughts, his speech, his acts, even his muscular move- 
ments have been so regulated and sensitized by training and 
intellectual development that his actions follow certain 
standards. 

Alcohol begins by removing this normal restraint. The 
over confidence in the ability to do, what the individual is 
manifestly unable to do, the uncalled for movements, the 
incoherent speech, the coarse emotions, all bespeak a re- 
moval of restraint or inhibition. It is evidently the result 



334 MATERIA MEDICA 

of lessening the action of the most highl}^ developed and 
the most recently acquhed mental fmictions of the brain. 
In other words, the effects of civilization are suddenly re- 
moved, the individual's actions approach those of uncivihzed 
barbarians, whose mentality is of a low grade. 

The removal of the normal restraint accounts for the 
greater play of the purely physical motor functions of the 
brain. But even these actions do not occur in a systematized 
coordinated normal fashion, as is evident from the boisterous 
laughter, the uncalled for tears, the apparently pm-poseless, 
staggering gait. The terminal muscular relaxation, the stupor 
and coma are conclusive effects of lessened brain action. 

Effect on temperature : Alcohol lowers the temperature be- 
cause the dilated blood vessels of the skin make the body 
lose heat. 

Effect on nutrition: Alcohol has a distmct food value. 
About 90% of the alcohol absorbed is used up in the body. 
It combines with oxygen and is changed to carbon dioxide 
and water. In this way it provides energy for the activity 
of the body cells. It is able, therefore, to take the place of 
such foods as carbohj^drates (starches, sugars) and fats. 

It is only suitable for temporary use, however, as in fevers; 
because if given for a long tune, alcohol injures the various 
organs and tissues of the body. This may neutralize any 
effect it ma3" have as a food. 

Action on the kidneys: Alcohol slightly mcreases the flow 
of urine. 

Excretion 

About 90% of every dose of alcohol given is used up in the 
body. The rest is rapidly eliminated by the kidneys, the 
lungs, and the skm, in the urine, the expired air, and the 
sweat. 

Acute Alcoholism 

xAcute alcoholic poisonmg results from drmking alcoholic 
liquors to excess. The effects constitute the familiar and far 
too common picture of drunkenness. 

Symptoms 
The effects may be divided into two stages: The stage of 



BRAIN AND SPINAL CORD DEPRESSANTS 335 

excitement, in which all the higher functions of the brain are 
lessened and the stage of stupor when all the brain actions 
are diminished. 

Excitement Stage 

The excitement may be increased and is often due to 
the brilliant surroundings in which alcoholic drinks are 
usually indulged. They may be entirely absent when taken 
under less inspiring conditions. 

The individual is usually talkative; his thoughts flow 
freely, perhaps too freely. The speech may be brilliant, but 
it is careless, loud, coarse and incoherent. It is not logical 
and there is a poor choice of words or sentences. The words 
themselves may not even be spoken distinctly. The in- 
dividual is usually jolly, boisterous and may suddenly 
become angry and quarrelsome. He may burst into a fit of 
tears or laughter. He often becomes coarsely sentimental 
and sensual. He usually moves about in an undignified man- 
ner but his gait soon becomes unsteady and staggering. The 
face is usually flushed and the pulse and breathing are rapid. 

When larger quantities are taken, the staggering gait be- 
comes very marked, nausea and vomiting occur and the 
patient passes into — 

The Stage of Depression 

The individual now falls into a deep sleep from which he 
can only be awakened with great difficulty (stupor) . All his 
sensations are lessened and he may not feel pain. His 
muscles are relaxed; and this frequently saves him from a 
fracture after a severe fall. His face is blue, the breathing 
is slow and snoring in character (stertorous) and the pulse 
is rapid, strong and bounding. Frequently there is loss of 
control of the rectum and bladder. 

When awakened he is usually dull and stupid and falls 
limply back with a thud. Finally he passes into a condition 
of coma (a deep sleep in which he cannot be aroused) and 
collapse; with a rapid, weak, thready pulse and dies. 

The effects of overdoses of alcohol vary with different 
individuals. Some become sentimental, others quarrelsome, 



336 MATERIA MEDICA 

and still others fall asleep and have no excitement stage at 
all. 

Fatal results have occurred from a dose of 500 c.c. (1 pint) 
of whiskey. 

Treatment 

1. Wash out the stomach. 

2. Give artificial respiration if the breathing is slow and 
shallow. 

3. Apply cold applications to the head. 

4. Keep the patient warm. 

5. Stimulants, such as strychnine, caffeine or a hot coffee 
enema are usually given. 

Chronic Alcohol Poisoning, ^^ Alcoholism'' 

Chronic alcohol poisoning results from habitually taking 
alcoholic liquors, especially distilled liquors, such as whiskey, 
gin, etc., which contain large percentages of alcohol. Rarely, 
the symptoms result from habitually drinking beers or wines. 

The injurious effects of alcohol are due to the fact, that 
when taken habitually, it dissolves some of the substances 
in the functionating cells of the various organs of the body. 
As a result, many of these cells are destroyed, and replaced 
by connective tissue, which is not an active part of an organ. 
The organ thus affected is then unable to perform its work 
as well as before, and the patient suffers from various symp- 
toms as a result of it. 

The organs usually affected are the stomach, the liver^ 
the blood vessels, the nervous system, and the kidneys. 

The stomach is affected by habitual alcoholism. Many 
of the cells of its hning membrane are destroyed, their place 
being taken by connective tissue, and chronic gastritis 
results. The secretion of gastric juice is then diminished 
and the patient suffers from various digestive disturbances. 

The secretion of mucus from the stomach is increased, 
the patient's tongue is dry and brown, and he usually com- 
plains of pain in the region of the stomach. Often he has 
nausea and vomiting in the morning. 

The liver is also frequently affected. Some of its cells 



BRAIN AND SPINAL CORD DEPRESSANTS 337 

being destroyed, and replaced by connective tissue, a con- 
dition known as cirrhosis of the liver results. This makes 
the liver very hard and interferes with its circulation. The 
patient then often develops fluid in the abdomen from 
accumulation of the blood in the abdominal vessels, and 
also suffers from digestive disturbances. 

The arteries become hardened by habitual alcoholism, 
because there is more connective tissue formed in their 
walls. This condition is known as arteriosclerosis. The 
patient then suffers from various symptoms as a result of 
the disturbed circulation in various organs, the blood pres- 
sure is very high, patients have continual headache, and 
numerous other symptoms. 

The heart may also be affected by alcohoL Many of its 
muscle fibers are destroyed and replaced by numerous areas 
of connective tissue. Disturbed heart action, often weakened 
heart action (myocardial insufficiency) may subsequently 
result. 

The kidneys are very frequently affected ; connective tissue 
replacing the cells which have been destroyed. The pa- 
tient then suffers from chronic nephritis (Bright's disease). 
Small quantities of urine are passed; there may be oedema 
of the extremities, fluid in the tissues, etc. 

Alcohol is particularly injurious to the nervous system. It 
destroys many of the cells of the gray matter of the brain. 
It is an important predisposing factor, often the cause, of 
various forms of insanity, of paralysis, and other disturb- 
ances of the nervous system. 

The nerves are frequently affected by alcohol. Paralysis 
of the muscles of the arms and legs often result from the 
effects of habitual alcoholism (alcoholic multiple neuritis) . 

Other evidences of chronic alcoholism are a red nodular 
nose, dilated blood vessels of the skin, especially on the face, 
and waxy, dry, soft skin. The mind is often sluggish and 
weak. 

Delirium Tremens 

This is a special kind of temporary alcoholic insanity, 
which occurs in habitual drinkers, when they receive any 



338 MATERIA MEDICA 

shock. This may be the result of an injury, haemorrhage^ 
an infectious disease, or a surgical operation. The symptoms 
are due to the patient being deprived of his usual amount 
of alcohol. 

The most common sjnnptoms are hallucinations of the 
various senses, abnormal fear, tremors of the muscles and 
excitement. 

The patient often sees various animals, such as snakes, 
rats, dogs, etc., before him (hallucinations of sight) or he 
feels them creepmg upon him (hallucinations of touch). 
Often he hears voices and is constantly talking to those who 
seem to be speakmg to hun. The patient usually has twitch- 
ing of the muscles of the extremities and is afraid of every- 
body about him. 

Deliriimi tremens may be avoided by giving alcohol regu- 
larly to those patients who take it habitually; whenever they 
are subject to any shock, or when they have undergone a 
surgical operation. 

Uses 

Locally, alcohol is used for the following effects : 

1. To harden the skin and prevent bed sores. 

2. As an antiseptic; 50-70% alcohol is the best preparation 
for such use. 

Internally, alcohol is used in the following conditions : 

1. As a cardiac and respiratory stimulant in cases of 
fainting, shock and collapse. Whiskey and brandy are the 
preparations used for this purpose. 

2. To check a cold after exposure, whiskey or brandy in 
hot water, relieves the congestion of the internal organs, by 
widening the vessels of the skin. 

3. In acute infectious diseases, such as typhoid fever, sep-. 
ticaemia, pyaemia, whiskey may be given as a food, to reduce 
fever, to lessen nervousness and to induce quiet and sleep. 

In such cases, the pulse wiU become slower, the tempera- 
ture is lowered, the breathing becomes slower and deeper. 
The delirium and other nervous symptoms are lessened, 
and sleep is induced. The tongue becomes moist and the 
skin perspires more profusely. 



BRAIN AND SPINAL CORD DEPRESSANTS 331^ 

When these effects are produced, alcohol is acting favor- 
ably. 

When, however, the pulse becomes rapid, the delirium, 
restlessness, uneasiness, and other nervous symptoms, are 
increased; the sleeplessness increases and the tongue and 
the skin remain dry, the alcohol is acting unfavorably, and 
the sjrmptoms should be reported to the physician. 

4. In convalescence it is given as a food and for its sooth- 
ing effect. In poisonous snake bite, alcohol, in the form 
of whiskey or brandy, should be given in very large doses. 

5. Beer, brandy, or whiskey and water, may be given at 
bedtime to produce sleep, especially when the inability to 
sleep is due to mental work or nervous strain. 

6. Brandy occasionally checks diarrhoea. 

7. Dilute alcohol is a very valuable antidote for carbolic 
acid poisoning. 

Tolerance 

Individuals who take alcoholic beverages habitually, 
can take large quantities of such drinks without any of the 
usual poisonous symptoms being produced. This condition 
is known as tolerance for alcohol. To obtain effects in such 
individuals, much larger doses than usual must be given, 
often even more than twice the usual dose. 

Administration 

For local use the preparations of alcohol are used. 

For internal use alcoholic liquors are principally used. 

For temporary use and for immediate effects the distilled 
Hquors, such as whiskey or brandy, are used. 

•They are best given hot, undiluted. Ordinarily, however, 
brandy or whiskey is best given diluted in a glass of vichy 
or seltzer filled with cracked ice, or with milk and egg in 
the form of a milk punch or egg nogg. 

In collapse brandy and whiskey are frequently given hypo- 
dermically. 

For continued use the fermented liquors such as wine or 
beer are used. 



340 MATERIA MEDICA 

Preparations 
For Local Use 
Alcohol 
(Alcohol) 

This contains 95% of ethyl alcohol by volume, and 92% 
by weight. It is used for rubbing the skin, to prevent bed 
sores. It is also used for burning purposes in alcohol lamps. 

Absolute alcohol 
(Alcohol absolutum) 

This contains 99% of ethyl alcohol. It is not ordinarily 
used, except by pharmacists and in laboratories. 

Dilute alcohol 
(Alcohol dilutum) 

This contains about 50% of ethyl alcohol by volume and 
about 41% by weight. This is the best preparation to use 
for antiseptic use. 

For internal use 

Alcoholic Beverages 

Distilled liquors 

Whiskey 15.0 c.c. B§ 

(Spiritus Frumenti) 

This contains about 44 to 50% of ethyl alcohol by weight, 
and about 50 to 56% by volume. Whiskey is made by dis- 
tilling fermented grain or other starchy plants. It should 
be at least four years old, because the fresh preparations are 
too injurious to the tissues. 

There are several kinds of whiskey: 

American whiskey, made by distilluig fermented rye and 
corn. 

Scotch whiskey, made by distilling fermented barley. 

Irish whiskey, made by distilling fermented potatoes. 

Brandy or Cognac 15.0 c.c. §^ 

(Spiritus Vini Gallici) 



BRAIN AND SPINAL CORD DEPRESSANTS 341 

This contains about the same percentage of alcohol as 
whiskey. Brandy is made by distilling fermented unchanged 
juice of fresh grapes. It should be at least four years old, 
because the fresh preparations are too irritating. There are 
two kinds of brandy: pale and dark. The dark brandy 
contains caramel. 

Brandy or cognac contains small quantities of tannin. 
As a result, it has a tendency to contract mucous membranes. 
It is therefore more soothing to the stomach and intestines, 
and has a tendency to constipate and check diarrhoea. 

Rum (not official) 15.0 c.c. §| 

Rum contains the same percentage of alcohol as whiskey. 
It is made by distilling fermented molasses. 

Gin (not official) 15.0 c.c. 5§ 

Gin contains about the same percentage of alcohol as 
whiskey. It is made by distilling fermented rye, or barley, 
and flavoring with juniper berries. Because of the juniper 
which it contains, gin increases the flow of urine (diuretic). 

Fermented Liquors 
Wines 

Wines are fermented liquors, made from grapes. Besides 
the alcohol, wines contain various acids, such as tartaric 
and tannic acids, and some volatile oils. 

There are several kinds of wines: 

White wines. « j. 
-, , . \ Sweet 

Red wmes. o 1 1- 

J Sparkhng 

White Wine (Vinum Album) 

White wines are made by fermenting grapes without the 
skins, stems or seeds. They contain 7 to 12% of alcohol. 

Dry wines are those which contain no added sugar. 

Sweet wines are those which contain sugar which has been 
added. 



342 MATERIA MEDICA 

Sparkling wines are those which are bottled before fermen- 
tation is complete. They contain carbon dioxide gas, and 
effervesce. 

The most important white wines are the following: 

Dry white wines, such as rhine wines. They contain about 
10% of alcohol. 

Sweet white wines, such as tokay wines. These contain 
about 14% of alcohol. 

Sparkling white wines, such as champagne, which is a 
French white wine. It is the most commonly used spar- 
kling white wine and contains about 10% of alcohol. 

Champagne should be given ice cold, in teaspoonful 
doses. It is particularly valuable in cases of nausea and 
vomiting, for example, after an operation. 

Champagne is not so effective when the gas escapes. 
This may be avoided by inserting a special tap in the cork, 
and keeping the bottle on ice, upside down. 

Red Wines (Vinum Rubrum) 

Red wines are made by fermenting colored grapes with 
the skins. They contain a larger percentage of alcohol than 
the white wines. 
Dry Red Wines : 
Claret 

This contains about 8-10% of alcohol. 
Sherry (Vinum Xericum) 

Sherry contains about 15-20% of alcohol and is often 
made artificially. 

Port Wine (Vinum Portense) 

This is the strongest red wine, and contains about 20-40% 

of alcohol. 

Sweet Red Wmes: The most commonly used sweet red 
wines are burgundy and madeira. They contaui from 6-20% 
of alcohol. 

Sparkling Red Wines : The most commonly used sparkhng 
red wine is sparkling burgundy, which contains about 10% of 
alcohol. 



BRAIN AND SPINAL CORD DEPRESSANTS 343 
Uses of Wines 

The wines are not as stimulating as the distilled liquors, 
such as whiskey or brandy. They are better suited, however, 
for continued use. They aid digestion when taken during 
meals. Sweet wines, however are apt to disturb digestion. 

The wines contain tannic acid and contract mucous mem- 
branes (astringent action). They are therefore more con- 
stipating than the distilled liquors. 

Sparkling wines, such as champagne, are soothing to the 
stomach when given in small doses. They are not as stimu- 
lating to the heart. Champagne causes intoxication rapidly, 
in spite of the small quantities of alcohol which it contains. 
When taken in larger quantities it is apt to cause headache, 
pain in the stomach, nausea, hiccough, etc. 

Beers 

Beers are made by fermenting starchy grains. They are 
usually made by fermenting brewed barley malt (barley 
which has been made to grow by artificial means and the 
growth stopped), with hops. 

Ale, porter and stout, are the various kinds of beers that 
are used. They contain about 3-10% of alcohol ^with a 
large amount of solids, mainly sugar and starches. Because 
of the starches and sugar which they contain, beers are very 
nutritious. They occasionally disturb digestion however. 

Liqueurs are preparations of volatile oils containing al- 
cohol. Many of them contain sugars. Kirchwasser is a 
Hqueur which contains very small quantities of hydrocyanic 
acid. 

Various essences of flowers, such as eau de cologne, contain 
large amounts of alcohol. " Cases of alcoholism occasionally 
occur from drinking eau de cologne, especially among women. 

WOOD ALCOHOL (METHYL ALCOHOL) 

Wood alcohol is made by the destructive distillation of 
wood. It is very inflammable, and because it is cheap it is 
used as a solvent for various substances. 



344 MATERIA MEDICA 

Wood alcohol is not used in medicine but it is of great 
interest because of its poisonous effects. These result from 
the fact that it is frequently substituted by unsciTipulous 
manufacturers for ordinary alcohol in the manufacture of 
essences such as soda water flavors, Jamaica ginger, witch 
hazel, bay rum, cologne, etc. ]\Iany patent medicines con- 
tain wood alcohol. Since the advent of prohibition the 
number of cases of wood alcohol poisoning have greatly in- 
creased because many beverages are prepared with wood 
alcohol since it is so difficult to obtain ordinary alcohol. 

Wood Alcohol Poisoning 

There are two forms of wood alcohol poisoning; the acute 
poisoning and the chronic poisoning. The acute symptoms 
follow the drinking of intoxicating or other liquors contain- 
ing wood alcohol. The chronic symptoms result from the 
continued use of local applications containing wood alcohol. 

Acute Wood Alcohol Poisoning 

Symptoms 

The symptoms are due to the fact that wood alcohol is 
not oxidized in the body as is ordinary alcohol, but affects 
principally the brain and nerves. 

The symptoms begin like an ordinary alcoholic intoxica- 
tion with excitement and exhilaration. This is foil owed by : 



nausea 



vomiting, 
dizziness, 
headache, 
dilated pupils, 
delirium. 

Persistent coma and death within a few hours or a few 
days. The patient may recover from the acute symptoms 
but may go bhnd just the same from destruction of the optic 
nerve (optic neuritis) . Bhndness has resulted from as little 
as five teaspoonfuls and death from a half a pint of wood 
alcohol. 



BRAIN AND SPINAL CORD DEPRESSANTS 345 

Treatment 

1. Wash out the stomach. 

2. Pour hot and cold water over the patient alternately. 

3. Give artificial respiration. 

4. Strychnine, caffeine and other stimulants are given. 

Chronic Wood Alcohol Poisoning 

Prolonged use of wood alcohol may cause blindness from 
destruction of the optic nerve (optic nerve atrophy). This 
may occur from its internal use or from external applications 
of various toilet preparations. 

There are numerous other alcohols such as propyl alcohol, 
butyl alcohol, amyl alcohol, etc., which result in the distilla- 
tion of ordinary wood alcohol. 



CHAPTER XVIII 

GENERAL ANAESTHETICS 

Anaesthetics are drugs used to produce insensibility 
to pain, so as to enable a surgical operation to be performed 
painlessly. The anaesthetics are divided into two groups : 

1. General Anaesthetics 

2. Local Anaesthetics 

General anaesthetics are drugs which produce insensi- 
bility to pain and a loss of all sensations throughout the 
body. No sensory impulses are then received by the brain, 
and the patient becomes unconscious and falls asleep. The 
effects of the general anaesthetics result from their circula- 
tion in the blood. 

Local anaesthetics are drugs which abolish sensations 
only on the particular area of the body where they are ap- 
plied. Since they do not abolish all sensory impulses, they 
do riot produce unconsciousness. 

In this chapter we shall consider only the general anaes- 
thetics. 

ETHER (AETHER) 

Ether is a colorless liquid formed by the combination of 
sulphuric acid and alcohol. It evaporates very easily, is 
very inflammable and has a very disagreeable odor and a 
burning taste. 

Ether was first used as an anaesthetic by an American 
dentist, Dr. Morton, in 1842. 

It is usually given by inhalation through a mask or spe- 
cially constructed apparatus, to produce insensibihty to pain. 
Its effects are quite similar to those of alcohol, which was 
formerly used in excessive doses to produce a mild anaesthe- 
sia. Chemically, ether is closely related to alcohol, being 
formed when alcohol is combined with oxygen. 

346 



GENERAL ANAESTHETICS 347 

Appearance of the Patient 
Ether Anaesthesia 
The most striking effect that may be noticed when ether is 
given to produce anaesthesia, is that the patient struggles 
and talks a great deal. It is customary, therefore, to divide 
the anaesthetic effects of ether, into three stages; according 
to whether the effects occur before the patient struggles, 
during the time of struggling, or after this stage has occurred. 
The three stages of ether anaesthesia are the following : 

1. The stage of imperfect consciousness, or first stage. 

2. The stage of excitement, or second stage. 

3. The stage of anaesthesia or complete unconsciousness, or 
third stage. 

Symptoms of the First Stage of Anaesthesia 

The patient has probably undergone various preparations 
for the operation, and has pictured in his mind various 
ideas of pain and suffering that the operation might produce. 
This makes him quite nervous and anxious, and the pulse 
quite rapid. He therefore regards every act of the doctor 
or nurse with suspicion. When the mask is applied to the 
face, the difficulty of obtaining air causes a choking sensa- 
tion, and the inhalation of the ether causes a burning pain 
in the throat, which often makes him cough and causes a 
profuse flow of saliva. Soon there is a feeling of warmth all 
over the body and the sensations become dulled. The sense 
of touch is blunted, objects are seen through a mist, and sounds 
appear to be at a distance. Often ringing, hissing or roaring 
sounds are heard. The muscles become stiff and the arms 
are held rigid. The face is flushed, the pupils are dilated, 
but they react to light. The pulse is rapid, and the breath- 
ing is rapid and irregular on account of the coughing and 
choking sensation. These effects last for about five or ten 
minutes and are soon followed by — 

The Symptoms of the Second Stage or Excitement Stage 

This stage begins with movements of the arms. The pa- 
tient tries to push the mask away, and attempts to get up. 
Many patients struggle violently, others shout, sing, groan. 



348 MATERIA MEDICA 

or burst into fits of laughter. These symptoms of excitement 
apparently result from dreams which the patient seems to 
have. The effects of these dreams vary with the mode of 
life and the temperament of the individual. Rehgiously 
inclined persons may sing hymns or pray; others become 
abusive; they swear and fight. Some become jolly, they 
laugh and sing. Many become emotional, and some have 
fears of injury or death. 

The pulse during this stage is rapid, the skin is flushed, 
often blue, the breathing is irregular because of the strug- 
gling. These symptoms last for a few minutes, the strug- 
gling then becomes lessened, the shouting and talking be- 
come indistinct, the breathing becomes very shallow and the 
patient passes into 

The Third Stage, or the Stage of Anaesthesia 

The patient now becomes calm, quiet and unconscious. 
All sensibihty is gone. The muscles are relaxed and the re- 
flexes disappear, so that when the skin is touched or incised, 
no response or movement is produced. Thus, touching the 
throat does not cause vomiting. The winking of the eye- 
lids which occurs when the eye is touched, often remains 
for some time, however. 

The pulse still remains rapid and strong, though it is slower 
than during the first and second stages. The breathing is 
deep and rapid and is often snoring in character. The pupil is 
usually contracted, and reacts to light and accommodation. 

This stage of anaesthesia, may be kept up for hours, ^by 
judiciously pouring small quantities of ether on the mask. 

When the ether is stopped, the patient may again be- 
come somewhat excited and talkative, he feels nauseated 
and vomits. He then slowly regains consciousness, often 
remaining asleep for a few hours before consciousness is re- 
gained, and complains of headache and dizziness for hours 
afterward. 

ACTION 
Local action : Applied to the skin, ether evaporates so rapidly, 
that it makes the skin feel cool. It also slightly numbs the 
sensation, acting as a mild local anaesthetic. 



GENERAL ANAESTHETICS 349 

On mucous membranes: It causes redness and increases 
the secretion of mucus. 

Internal Action 

In the mouth: It has an unpleasant burning taste, and it 
increases the flow of saliva by the reflex action started by 
the redness of the mucous membrane which ether causes. 

In the stomach : It increases the secretions of the mucous 
membrane, and slightly checks the formation of gas (car- 
minative action) if given diluted. 

In the intestines: Ether causes redness and swelling of 
the mucous membrane with profuse secretion of mucus. It 
relieves colic and is said to destroy intestinal worms (an- 
thelmintic action). 

Action after Absorption 

Ether is absorbed into the blood in a few minutes, through 
the mucous membranes of the lungs, stomach or intestines. 
After absorption it affects principally the brain, the heart 
and the respiration. 

Action on the brain : The effects of ether on the brain, are 
quite similar to those of alcohol. When given internally it 
has a tendency to soothe nervousness. It first lessens the 
higher intellectual, and then all the centers of the brain. 

The uncontrolled talkativeness, the constant movements, 
the dreams occurring during the excitement stage, are all 
evidences of removal of restraint ; from the speech, the motor 
and the imaginative centers of the brain. The loss of sen- 
sibility, the unconsciousness and the relaxations of all the 
muscles which follow the excitement stage, and which are 
present during the stage of anaesthesia, are the result of the 
diminished activity of the sensory and motor areas of the 
brain. The unconsciousness results because the appreciation 
of sensations is lessened. 

Action on the spinal cord: The reflex action, which is 
the type of action prevalent in the spinal cord, is at first 
increased, but soon lessened, and then entirely abohshed by 
ether. Many reflexes, however, such as the reaction of the 
pupil to light, the movements resulting when the sphincter 
is stretched, remain for a long time. 



350 MATERIA MEDICA 

Action on the respiration: Ether makes the breathing 
faster and deeper. During the excitement stage of anaes- 
thesia, however, the breathing may be irregular, because of 
the struggUng and contractions of the muscles for breathing. 

Action on the lungs: Ether increases the secretions of the 
mucous membranes of the bronchi and lungs. 

Action on the circulation: Ether makes the heart beat 
stronger and faster. It contracts the blood vessels and in- 
creases the blood pressure. It dilates the blood vessels of the 
skin, however. 

The characteristic pulse of ether is therefore rapid and 
strong. During the third stage of anaesthesia, the rate of 
the pulse is about normal, or a little above normal. As the 
anaesthesia progresses, however, the pulse gradually be- 
comes weaker. 

Action on the blood : Ether has a tendency to destroy red 
blood corpuscles. 

Action on the muscles: When ether is given as an anaes- 
thetic all the muscles are relaxed in the third stage. 

Action on the pupils: During the first and second stages 
of anaesthesia, the pupils are dilated because of the excite- 
ment. During the third stage, the pupils are contracted, 
but they react to light. 

Action on the kidneys: Ether is somewhat injurious to 
the kidneys. After a prolonged anaesthesia, it often causes 
albumin in the urine. 

•Excretion 

Ether is very rapidly eliminated from the body, by the 
expired air of the lungs, usually in about a half hour. When 
given as an anaesthetic, it is entirely excreted in about 24 
hours ; the breath has its unpleasant odor during that time. 

Idiosyncrasies 

The most common variations in the effects of ether are 
the following : 

1. In some individuals, and in children, there may be no 
excitement stage. 

2. Patients who have been used to taking alcoholic hquors 



GENERAL ANAESTHETICS 351 

regularly, requiie larger quantities of ether to produce 
anaesthesia. These patients usually struggle a great deal. 

3. In some individuals, very small quantities may cause 
poisonous effects. 

Poisonous Effects or " Ether Collapse " 

Acute ether poisoning or ether collapse, usually resulti=i 
when too much ether is given to produce anaesthesia. 

Symptoms 

1. The first symptom which indicates that too much 
ether is being administered, is slow, shallow and gasping 
breathing. 

2. The face then becomes blue and cyanotic and the 
breathing stops. 

3. The pulse may not become affected, but it soon be- 
comes weak and irregular. 

4. The pupils are widely dilated, and do not react to light. 
The pulse gradually grows weaker, and death finally results 
from respiratory paralysis. 

Treatment 

1. Stop anaesthesia; take the mask away. 

2. Give artificial respiration. 

3. Elevate the foot of the table. 

4. Stretch the sphincter of the rectum to induce breathing 
by the reflex action thus produced. 

5. Give heart and respiratory stimulants such as caffeine, 
strychnine, atropine, etc. 

Usually, if the collapse is recognized early, these measures 
will revive the patient. 

Dangers of Ether Anaesthesia 

The following symptoms occurring during anaesthesia 
often warn the anaesthetist of impending trouble. 

1. Slow, shallow breathing. 

2. Dilated pupils which do not react to light. 

3. Slow, weak, irregular pulse. 



352 MATERIA MEDICA 

4. Often the relaxed muscles of the tongue, cause the 
tongue to fall back and obstruct the breathing. 

5. In some cases, continued vomiting of the contents of 
the stomach and intestines, during deep anaesthesia, may 
cause food particles to enter the lungs and cause asphyxia. 
This can be avoided by constantly keeping the mouth 
thoroughly mopped out. 

Dangers Following Anaesthesia 

The most common condition that may occur after ether 
anaesthesia is pneumonia. This may result from the in- 
jurious effect of ether on the lungs. 

Preparations for Anaesthesia 

Before administering ether, the following measures should 
always be carried out, but the nurse must receive these 
orders from the surgeon. 

1. Move the bowels by a cathartic, about twelve hours 
before the operation, and give an enema the morning of the 
day the patient is to be operated upon. 

2. Do not give any food or drink for about twelve hours 
before the operation. This often lessens the vomiting after 
the anaesthesia. 

3. Catheterize the patient before the operation. 

4. Remove all false teeth, so that the patient will not swal- 
low them during the anaesthesia. 

5. When the anaesthesia is begun, the eyes should be 
covered with a piece of gauze, and the face protected with 
vaseline to avoid the injurious effects of the ether fumes. 

Administration 

To produce anaesthesia, ether is given by inhalation 
through a mask held over the nose and mouth, in the follow- 
ing ways: 

The Open Method or Drop Method 

The ether is poured drop by drop on a mask covered with 
gauze, and the patient is then allowed to inhale the ether 



GENERAL ANAESTHETICS 353 

vapor which is thoroughly mixed with air. This is the most 
common method of administration now in use. 

The Closed Mask Method 

This method is gradually being abandoned. The ether is 
given through a cone saturated with ether, which is thus mixed 
with very little air. 

Gas Ether Method 

This is a very common method now in vogue, whereby 
the patient is first given nitrous oxide gas, and then ether. 
In this way, many of the unpleasant effects of ether, and the 
excitement stage, are avoided. 

There are numerous kinds of apparatus for giving ether 
by this method, many of which have various advantages, 
such as warming the vapor, etc. 

Other Methods of Anaesthesia 

Ether is also occasionally given as an anaesthetic by the 
rectum, by means of a specially constructed apparatus. 

Recently, a method has been devised for producing anaes- 
thesia by giving ether intravenously. The ether is given in 
an infusion of salt solution. 

In giving an anaesthetic, it is important that the drug be 
administered very slowly. The breathing and pulse should 
be watched very carefully throughout the anaesthesia, so as 
to avoid serious dangers. 

Uses 

Besides its use as an anaesthetic, ether is used for the fol- 
lowing effects : 

1. As a heart stimulant. 

2. To check convulsions. 

3. As a carminative, to lessen the formation of gas m the 
stomach and intestines. 

Preparations 
Ether 0.5-1.0 c.c. m. viii-xv 

(Aether) This contains 96% of ether, and is used principally 
as an anaesthetic. The dose of ether for anaesthesia varies 
with the patient, and the degree of anaesthesia desired. 
Spirits of Ether 2.0-4.0 c.c. 3|-i 

(Spiritus Aetheris) 



354 MATERIA MEDICA 

This consists of 32 parts of ether and 68 parts of alcohol. 

Compound Spirits of Ether 2.0-4.0 c.c. 5 J— 1 

(Spiritus Aetheris Compositus) 
(Hoffman's Anodyne) 

This contains 32% of ether, alcohol and other substances 
known as ethereal oils. It is used principally to check the 
formation of gas in the stomach and intestines, and as a 
remedy for fainting. It is usually diluted with cold or iced 
water. 

Spirit of Nitrous Ether 1.0-4.0 c.c. m. xv-5i 

(Spiritus Aetheris Mtrosi) 
(Sweet Spirit of Niter) 

This preparation is used to increase the perspiration and 
the flow of urine, but it also causes the same stimulating 
effects as ether. 

CHLOROFORM 

Chloroform is a colorless non-inflammable fluid, which 
evaporates easily, but not as rapidly as ether. It is formed 
by the combination of alcohol with chlorine. Chemically, 
it is a compound of methane (marsh gas) with chlorine 
forming trichlor methane or chloroform. It is used princi- 
pally as an anaesthetic. 

Chloroform Anaesthesia 

When chloroform is given as an anaesthetic, the symptoms 
it produces can be divided into three stages as in ether anaes- 
thesia. 

During the first stage, the patient is nervous, anxious, 
and his sensations are dulled, but the anaesthetic is more 
pleasant to take than ether. The pulse is usually rapid. 

Very soon, the second stage sets in, the excitement, talka- 
tiveness and struggling, however, are usually much less, and 
last for a shorter time than with ether. This stage is very 
often entirely absent. 

The stage of anaesthesia, or third stage, comes on very 
rapidly with chloroform. The patient is calm, quiet and 
unconscious. , The breathing is slow and shallow, the rate of 



GENERAL ANAESTHETICS 355 

the pulse is normal, perliaps somewhat slower but weak. The 
face is pale, and the pupils are contracted, but they react 
to light. All sensibihty and reflex action are gone, and the 
muscles are relaxed. 

With chloroform, anaesthesia is induced more rapidly 
than with ether, usually in about five or ten minutes. The 
muscles become relaxed sooner, the pulse is weak and slower 
and the breathing is shallow. 

ACTION 

Local action: Applied to the skin, the sensibility is some- 
what lessened by chloroform, and it causes redness and a 
burning sensation. If it is prevented from evaporating, it 
may form a blister. On mucous membranes: It causes red- 
ness and increases the secretion. 

Internal Action 

In the mouth: It has a hot sweetish taste and it increases 
the flow of saliva. 

In the stomach: It causes a feeling of warmth and checks 
the formation of gas (carminative action) . It increases the 
secretion and the peristalsis. It is usually absorbed from the 
stomach and does not enter the intestines. 

Action after Absorption 

Chloroform is absorbed into the blood through the mucous 
membrane of the stomach in about fifteen minutes, when 
given by mouth. When inhaled as an anaesthetic, it enters 
the blood from the mucous membrane of the lungs still more 
rapidly. It is also readily absorbed through all the mucous 
membranes. After absorption it affects principally the 
brain, the heart and the respiration. 

Action on the brain: Chloroform produces the same 
effects on the brain as ether does. It causes progressive 
depression of the brain centers beginning with the higher 
intellectual centers, followed by rapid depression of the 
other centers as well. The result of this action, is a prelimi- 
nary stage of excitement and talkativeness, followed 



356 MATERIA MEDICA 

by unconsciousness, loss of sensation and relaxation of the 
muscles. 

Action on the spinal cord: Chloroform at first increases, 
and then lessens the reflex action throughout the body. 

Action on the respiration; It makes the breathing slower 
and shallower. 

Action on the lungs: Chloroform does not increase the 
secretion of the lungs as much as ether does. 

Action on the circulation: Chloroform makes the heart beat 
slower and weaker, by weakening the contractions of the 
heart muscle. It widens the blood vessels and lowers the 
blood pressure. The chloroform pulse is slow and weak. 

Action on the blood: Chloroform has a tendency to de- 
stroy red blood corpuscles. 

Action on the pupil: The pupil is contracted, but it re- 
acts to light and accoromodation. 

Action on the muscles : Chloroform relaxes all the muscles 
of the body. 

Action on the kidney: It is distinctly injurious to the 
kidney, and changes some of the constituents of the kidney 
cells to fat. It often causes albumin in the urine. 

Excretion 

Chloroform is rapidly eliminated, mainly by the expired 
air of the lungs; though some of it is also excreted by the 
urine and the perspiration. 

Poisonous Effects 
Chloroform poisoning occurs in two forms; 

1. Acute Chloroform Poisoning 

2. Delayed Chloroform Poisoning 

Acute Chloroform Poisoning 

Acute chloroform poisoning usually results when too much 
chloroform is given as an anaesthetic; or in susceptible in- 
dividuals, from very small quantities ; even from a few 
drops. 



GENERAL ANAESTHETICS 357 



Sudden Chloroform Death 



Sudden death occasionally occurs from chloroform, in 
susceptible individuals, even when only a few drops are 
administered for anaesthesia. 

This usually occurs during the first stage of anaesthesia. 
The pulse becomes very slow and weak, the face turns pale, the 
breathing becomes very shallow and slow, the pupils are widely 
dilated, and the patient dies in a few minutes. 

This very unfortunate occurrence is the result of the 
coughing and burning pains in the throat which occur dur- 
ing the first stage of anaesthesia. Impulses are thus sent 
to the Vagus center in the medulla, which then sends in> 
pulses to the heart to make it beat slower. ' (Reflex action.) 

Such impulses usually cause fainting, which is a condi- 
tion in which the heart stops beating for a few moments^ but 
soon recovers again. In sudden chloroform death, however, 
the heart muscle is poisoned by the chloroform; so that 
after it has suddenly stopped beating, it does not contract 
again, and death results. 

If atropine is given before chloroform anaesthesia, it 
occasionally acts as a safeguard against this dreaded acci- 
dent. The atropine paralyzes the nerve endings of the Vagus 
nerve in the heart, and prevents impulses to slow the heart 
contractions, from reaching it. 

When sudden chloroform collapse occurs, it is usually 
treated by giving atropine and other heart stimulants hypo- 
dermically, and massaging the chest over the heart. Every 
now and then patients recover after vigorous treatment. 

Symptoms of Chloroform Collapse 

When too much chloroform is given during anaesthesia, 
the following symptoms usually result, in the order of their 
onset. 

1. The pulse becomes slow, weak and irregular, usually 
about 50 or 40 to the minute. 

2. Slow and shallow breathing. 

3. Pallor of the skin. 

4. The pupils are widely dilated, and do not react to light 
or accommodation. 



358 MATERIA MEDICA 

5. The pulse and breathing become still slower, and the 
patient dies from paralysis of the heart. 

Treatment 

1. Stop the anaesthesia, and take the mask away as soon 
as the slow and weak character of the pulse is noticed. 

2. Stimulants such as atropme, caffeine, strychnine, etc., 
are usually given. 

3. Give artificial respiration. 

4. Elevate the foot of the table. 

Delayed Chloroform Poisoning 

This form of chloroform poisoning occm-s occasionally. 
The symptoms appear about a few days after the anaes- 
thetic has been administered. It is due to the destruction 
of many of the cells of the liver, kidne^^s, and heart, which 
then become filled up with fat globules (fatty degeneration). 

Symptoms 

1. Nausea and vomiting; the vomited matter containing 
bile. 

2. Jaundice. 
.3. Delirium. 

4. Convulsions. 

5. Scanty urine, which contains albumin, and two sub- 
stances characteristic of this condition, leucin and tyrosin. 

6. Collapse (slow, weak pulse, slow, shallow breathing, 
etc.). 

The patient usually dies in a few days from profoimd 
collapse. 

Administration 

Chloroform is usually given by inhalation, by means of 
a mask covered with gauze, which is held over the patient's 
nose and mouth. A few drops of chloroform are poured 
on the mask and allowed to mix thoroughly with air. Dan- 
gers of chloroform are best avoided by pouring the chloro- 
form very slowly, a drop at a time, and allowing the vapor 
to thoroughly mix with air. 



GENERAL ANAESTHETICS 359 

The nurse is often called upon to give chloroform during 
labor, in obstetrical cases. Very little chloroform should 
then be given, as in such cases it is only necessary to ad- 
minister the chloroform when the patient has severe pains. 
Complete anaesthesia is not desired in these cases, as the 
uterine contractions are then lessened, and the birth of the 
child is thus retarded. The pulse and breathing should be 
watched very carefully throughout the anaesthesia. 

Uses 

Beside its use as an anaesthetic, chloroform is given : 

1. To stop convulsions (by inhalation). 

2. To check diarrhoea and to lessen colic (by internal ad- 
ministration). 

3. Chloroform liniment is frequently used as a local ap- 
plication to relieve pain. 

Preparations 

For Internal Use: 

Chloroform 0.06-1.0 c.c. m. i-xv 

(Chloroformum) 

The dose of chloroform for anaesthesia, varies with the 
patient, and the degree of anaesthesia desired. 

Chloroform should always be kept in brown bottles, as it 
is readily decomposed into dangerous substances, by the 
action of hght. 

Spirits of Chloroform 2.0-4.0 c.c. m. xxx-5 i 

(Spiritus Chloroform!) 

This contains 10% of chloroform. 

Emulsion of Chloroform 15.0-30.0 c.c. §4-i 

(Emulsum Chloroform!) 

This contains 4% of chloroform. 

Clilorodyne 0.3-2.0 c.c. m. v-xxx 

(Not official) 

This contains chloroform, ether, hydrocyanic acid, mor 
phine and cannabis indica. 



360 



MATERIA MEDICA 



For Local Use: 
Chloroform Liniment 
(Linimentum Chlorof ormi) 

This consists of soap hniment and chlorof orni; and con= 
tains 30% of chloroform. 

Compound Chloroform Liniment (not official) 
(Linimentum Chloroformi Compositus) 

This contains chloroform; oil of turpentine, laudanum^ 
tincture of aconite, and soap hniment. 



COMPARATIVE ACTION OF ETHER AND CHLOROFORM 



ETHER 

1. Inflammable 

2. Cools the skin 

3. Unpleasant to take 

4. Anaesthesia induced with 

larger quantities, and 
not as deep. 

5. ]\Iarked excitement stage 

6. Pulse rapid and strong 

7. Skin bright red in color 

8. Suitable in cases where the 

heart action is weak or 
where the kidneys are 
diseased. 



CHLOROFORM 

1. Not inflammable 

2. Bums the skin 

3. [More pleasant to take 

4. Deeper anaesthesia induced 

with smaller quantities. 

5. Little or no excitement stage 

6. Pulse slow and weak 

7. Skin pale 

8. Suitable in cases where the 

lungs are diseased or in 
drunkards. 



9. Respiratory collapse 



Dangers 

9. Cardiac collapse 



After Effects 



10. More vomiting 

11. Apt to cause pneumonia 



10. Less vomiting 

11. Apt to cause delayed chloro- 

form poisoning 



ETHYL BROMIDE (AETHYLIC BROMIDUM) (not official) 

Ethyl bromide or bromide of ether, is a colorless liquid 
which evaporates easily. It has a disagreeable, sweetish 
taste, and an ethereal odor. 



GENERAL ANAESTHETICS 361 

ACTION 

Ethyl bromide is used to produce anaesthesia, especially 
for short operations, or to begin an ether anaesthesia. Its 
effects are similar to those of chloroform, and it has the 
same weakening action on the heart. When its administra- 
tion is stopped, consciousness returns very quickly, and 
the patient feels quite weak. It is usually given as a con- 
centrated vapor, mixed with very little air. 

It should be kept in brown bottles, as it is decomposed very 
easily by the action of light, forming dangerous substances. 

ETHYL CHLORIDE (AETHYLIC CHLORIDUM) 

Ethyl chloride, chloride of ether or kelene, is formed by 
the action of hydrochloric acid gas on alcohol. It evaporates 
very easily. It usually comes in special glass containers, 
with a long, pointed tip, which is broken off or unscrewed. 
A fine stream of vapor then shoots out, which is directed on 
the mask; or, for local anaesthesia, on the skin. 

ACTION 

Local action: Because it evaporates very easily, ethyl 
chloride freezes the skin over which it is applied, producing 
local anaesthesia of the part. Minor surgical operations 
can be performed under such local anaesthesia. It should 
be apphed until the tissues become white and hard, then 
stopped; if it is continued after this effect is obtained it is 
apt to injure the tissues. 

General Action 

Ethyl chloride is also used as a general anaesthetic. It 
produces anaesthesia very rapidly, usually in about 1 to 5 
minutes. 

Its effects are similar to those of chloroform, but it does 
not cause complete muscular relaxation. The pulse is slow 
and weak, and the breathing is deep. The patient usually 
recovers from the effects very rapidly. It is usually given 
to start an ether anaesthesia. It is not suitable for pro- 
longed use, because it weakens the heart even more than chlo- 
roform and it does not cause complete muscular relaxation. 



362 MATERIA MEDICA 



PENTAL 



Pental is a colorless liquid made from fusel oil. Chemically! 
it is trimethylethylene. 

It has been used to produce anaesthesia for short opera- 
tions, and it produces no after effects. Its effects are similar 
to those of ether or chloroform, but it does not cause much 
muscular relaxation. It has no effect on the heart or respira- 
tion. It occasionally causes twitchings of the muscles, or 
convulsions, even during anaesthesia. 

METHYLENE BICHLORIDE (not official) 

Methylene bichk)ride is an inflammable, colorless fluid 
which has an odor like chloroform. Its effects are similar 
to those of chloroform. It produces rapid anaesthesia which 
soon wears off. It slows and weakens the heart action. 

ANAESTHETIC MIXTURES 

The following preparations are mixtures of various anaes- 
thetics. They are said to have various advantages over a 
single anaesthetic. 



This consists of 



A. C. E. MIXTURE 

Alcohol 1 

Ether 2 Parts by volume 

Chloroform 3 

ANAESTHOL 

This is a mixture of 

Chloroform 36% 

Ether 47% 

Ethyl Chloride 17% 

This mixture is said to have the same boiling point as 

the blood, and therefore to be easily excreted. The dangers 

of chloroform are thus said to be avoided. 

When these mixtures are given, the ether and the ethyl 
chloride evaporate more quickly than the chloroform. 



GENERAL ANAESTHETICS 363 

The anaesthetist is then giving concentrated chloroform, 
instead of a diluted mixture. Dangerous symptoms are 
thus more apt to follow, especially in warm weather, since 
the ether and other ingredients evaporate more easily than 
the chloroform. 

SOMNOFORM 

This is a mixture of 

Ethyl Chloride 65% 
Ethyl Bromide 5% 
Methyl Chloride 30% 

NITROUS OXIDE GAS (LAUGHING GAS) 

Nitrous oxide gas is a colorless gas without any odor. It 
is made by distilling ammonium nitrate. The gas is passed 
through water, and collected in small metal cylinders, in 
which it usually comes for practical use. It is the safest 
and most pleasant anaesthetic known. 

Appearance of the Patient 
Nitrous Oxide Anaesthesia 

A few seconds after inhaling nitrous oxide gas, the patient 
usually feels rushing, drumming or hammering noises in the 
ears, the sight becomes indistinct, and he has a feeling of 
warmth and comfort all over the body. The arms and legs 
move constantly about, the patient is bright, lively, very jolly, 
and bursts out into fits of laughter (hence the name ^ laughing 
gas"). These symptoms last for about 2 or 3 minutes and 
then the patient feels drowsy, falls asleep, and loses all sen- 
sibility. 

During the anaesthesia, the face is dark red in color, often 
blue, the breathing is deep and snoring in character, the pulse 
is slow, strong and tense, and the blood pressure is very high. 
If the nitrous oxide is judiciously mixed with air, the anaes- 
thesia can be kept up for a half to one hour. 

AS soon as the mask is taken away, however, the patient 
becomes conscious in about 1 to 3 minutes, and has no after 
effects, except perhaps a sHght headache, which iray persist 
for a few hours. 



364 MATERIA MEDICA 

Nitrous oxide does not relax the muscles, so that pro^^ 
longed abdominal operations cannot be performed under 
its anaesthesia. 

ACTION 

Nitrous oxide is a gas which is only given by inhalation to 
produce anaesthesia. It is absorbed into the blood from the 
lungs almost immediately. The symptoms which it pro- 
duces are due to its action on the brain, the blood and respira- 
tion. 

Action on the brain: The noises in the ears, the move- 
ments of the extremities, the laughter, are all evidences of 
increased activity of the brain. These S3niiptoms last for a 
few minutes and are almost immediately followed by symp- 
toms of lessened brain activity; such as sleep and loss of 
sensation. 

Action on the respiration: Nitrous oxide gas, by taking 
che place of oxygen in the lungs and in the blood, prevents 
the haemoglobin from obtaining its necessary oxygen. The 
patient then suffers from asphyxia. This makes the breath- 
ing deep and snoring in character (stertorous), and the blood 
becomes blue in color so that the face has a purple or blue 
color during anaesthesia. 

Action on the heart: The slow, strong pulse and high 
blood pressure are the result of the asphyxia, and are not 
due to any effect on the heart or blood vessels. 

Excretion 

Nitrous oxide gas is eluninated from the body in a few 
minutes by the expired air. 

Poisonous Effects 

When too much nitrous oxide is given, the following 
(Symptoms are produced, because the haemoglobin is unable 
to obtain its necessary oxygen. The blood is then impure 
and is poisonous to the brain and other organs of the body. 

Symptoms 
1. The face is blue in color. 



GENERAL ANAESTHETICS 365 

2. The breathing is difficult and deep. 

3. Slow, strong pulse, with very high blood pressure. 

4. Convulsions. 

These symptoms disappear as soon as the nitrous oxide is 
stopped. 

Administration 

Nitrous oxide gas is usually given by inhalation^ by means 
of a specially constructed apparatus, consisting of a mask 
attached to a large rubber bag, which is filled with the gas 
from a metal container. 

Uses 

Nitrous oxide gas is used to produce anaesthesia for short 
surgical operations, and to begin ether anaesthesia, so as 
to avoid its unpleasant symptoms and excitement stage. 

It is frequently given together with oxygen for a prolonged 
anaesthesia. 



CHAPTER XIX 

HYPNOTICS 

Hypnotics, soporifics, narcotics, or somnifacients, are 
drugs which lessen the activity of the brain, and produce 
sleep, or unconsciousness. 

Their effects are similar to those of the general anaesthet- 
ics, but they are milder, more lasting, and do not relieve pain. 

The hypnotics are usually given by the mouth and are 
slowly absorbed; their effects lasting for several hours. 

Mode of Action 

Our consciousness depends upon the impulses received 
from our surroundings through the various senses. Hyp- 
notics, by lessening the activity of the brain, also lessen 
the activity of its sensory areas, so that fewer impulses are 
received from our environments, and unconsciousness or 
sleep results. 

When the activity of the sensory areas is lessened, the 
appreciation of pain, one of the sensations, is also lessened ; 
so that many of the hypnotics relieve pain (analgesic action) 
besides producing sleep. 

The most efficient hypnotic is chloral. 

MORPHINE AND OPIUM 

Morphine and opium produce sleep when the patient is 
unable to sleep on account of pain. Their effects have been 
more fully described under their more important actions. 
(See page 299.) 

BROMIDES 

Bromides produce sleep when the patient is unable to 
sleep on account of nervousness. 

CHLORAL 

Chloral is an oily, colorless liquid made by the combina- 
tion of chlorine gas with absolute alcohol. It is not used in 

366 



HYPNOTICS 307 

medicine, but when it is combined with water, it forms 
crystals of chloral hydrate, which is the preparation or- 
dinarily used. 

Appearance of the Patient 

About 5 to 15 minutes after an average dose of chloral 
hydrate is given, the patient feels tired and drowsy, and 
soon falls asleep. The sleep lasts for about five to eight 
hours. It resembles the natural sleep, and the patient can 
be easily awakened; by pain, loud sounds, or when touched. 
During the sleep, the pulse and breathing are slow, and 
the pupils are contracted. 

When the patient awakes, he may complain of a little 
headache and dizziness, and may be somewhat confused. 

ACTION 

Local action: Applied to the ^kin, chloral causes redness 
and even blisters. It also acts as an antiseptic, checking 
the growth of bacteria. On mucous membranes it causes 
redness and increases the secretions. 

Internal Action 

In the mouth it has a hot, burning taste. 
In the stomach and intestines: It increases the secretions. 
It occasionally causes nausea and vomiting. 

Action after Absorption 

Chloral is very rapidly absorbed into the blood through 
the mucous membrane of the stomach and intestines; usually 
in about 5 to 15 minutes. After absorption, it affects prin- 
cipally the brain, the heart, and respiration. 

Action on the brain: Chloral lessens the activity of the 
brain. The sensory areas are particularly affected; so that 
the brain does not appreciate the impulses received through 
the various senses, and unconsciousness or sleep then results. 
Very intense sensations, such as pain, are appreciated, how- 
ever; and these may even prevent sleep. Chloral also 
lessens the motor activities of the brain. 



368 MATERIA MEDICA 

Action on the spinal cord : The reflex actions of the spinal 
cord are lessened by chloral. External stimuli applied to 
various parts of the body therefore produce a slow response. 

Action on the heart: Chloral makes the heart beat slower 
and weaker by weakening the contractions of the heart mus- 
cle. The pulse then becomes slower and weaker. 

Action on the respiration: The breathing becomes some- 
what slower and shallower, because fewer impulses for breath- 
ing are sent out from the respiratory center in the medulla. 

Effect on the temperature : Chloral lowers the temperature 
several degrees by lessening the muscular movements, so 
that less heat is produced. 

Excretion 

Chloral is eliminated from the body mainly by the kid- 
neys in several hours, as urochloralic acid. 

Idiosyncrasies 

Chloral often causes the following unusual effects : 

1. Redness and swelhng of the conjunctiva of the eye. 

2. Flushed face and neck. 

3. Eruptions: large, red areas on the skin, which are often 
distinctly raised above the surface (wheals). The eruptions 
often peel (desquamate) . 

4. Dyspnoea. 

5. Rise of temperature. 

Dangerous Symptoms 

Chloral Collapse 

In giving chloral, the patient must be carefully watched, 

and the pulse should be taken very frequently; as sudden 

heart failure from chloral is not at all uncommon, even from 

a single dose. 

Symptoms 

1. Restlessness. 

2. Slow, weak pulse. 

3. Slow, shallow breathing. 

4. Coma. 



HYPNOTICS 369 

The chloral should be stopped when these symptoms 
appear. 

The danger is usually over when the pulse is above 60 and 
is regular and strong. 

Tolerance 

If chloral is taken habitually, the patient becomes accus- 
tomed to the drug, so that large doses may be taken with- 
out producing any poisonous effects. 

Poisonous Effects 

Acute chloral poisoning is a condition which may result 
when an overdose of chloral is given medicinally, or from 
the malicious administration of an overdose of chloral in 
alcohol (^'knockout drops")* 

Symptoms 

1. Very deep sleep from which the patient is aroused with 
difficulty. (Stupor.) 

2. Very slow and shallow breathing. 

3. Slow, weak, irregular pulse with low blood pressure. 

4. Insensibility to pain. 

5. Contracted pupils. 

6. Relaxation of the muscles. 

7. Coma (deep sleep from which the patient cannot be 
awakened). 

8. Collapse. 

Death usually results from paralysis of the heart and 
breathing. The smallest fatal dose is 2.0 gms. (grs. xxx). 

Treatment 

1. Wash out the stomach. 

2. Give artificial respiration. 

3. Keep the patient warm and quiet. Excitement may 
be fatal. 

4. Atropine, caffeine, strong coffee, or alcohol are usually 
given to increase the action of the heart and respiration. 



370 MATERIA MEDICA 

Chloral Habit 

Habitual use of chloral often causes symptoms resembling 
those of chronic alcoholism. Many of the constituents of 
the cells of the various organs of the body, such as the liver 
and kidney are changed to fat globules. The following 
symptoms usually result from this condition : 

1. The patient feels melancholic and ''blue.'' 

2. Wakefulness and nervousness at night. 

3. Loss of appetite and disturbed digestion. 

4. Various eruptions on the body. 

If the drug is suddenly stopped, symptoms resembling 
delirium tremens result. To relieve these symptoms, the 
patient must be gradually weaned of the habit. 

Uses 
Chloral is used principally: 

1. To produce sleep. 

2. To lessen the excitement of delirium tremens and other 
similar conditions. 

3. To prevent the convulsions of strychnine poisoning, 
epilepsy, uraemia, etc. 

Administration 
Chloral hydrate is best given only slightly diluted in 
syrup, about 15 minutes to a half hour before bedtime. 

Preparations 

Chloral Hydrate 0.6-2.0 gms. grs. x-xxx 

(Chloralum Hydratum) 

Croton Chloral Hydrate 0.3-1.3 gm. grs. v-xx 

or 
Butyl Chloral Hydrate 

This resembles chloral in its effects; it is not as efficient 
but the effects are more lasting. It particularly lessens the 
sensations carried from the face by branches of the fifth 
cranial nerve. It is therefore frequently used to relieve the 
intense pain of trifacial neuralgia C'tic douleureux")o 

Metachloral (not official) 



HYPNOTICS 371 

This is a substance made by the action of sulphuric acid 
on chloral. It is used as a local anaesthetic. 

Bromal Hydrate (not official) 0.12-0.3 gm. grs. ii-v 

This substance is formed by the action of bromine on 
alcohol. It acts like chloral, but is more dangerous. 

Chloral Camphor: This consists of equal parts of chloral 
and camphor and is used as a local application to relieve 
pain. 

CHLORALFORMAMID 

Chloralformamid is a white, crystalline powder with a 
slightly bitter taste. It is a chemical compound of chloral. 

It produces sleep; its effects are similar to those of chloral. 
It does not weaken the heart action, but it is not as reUable 
as chloral. 

Preparations 
Chloralformamid 1.0-2.0 gms. grs. xv-xxx 

It is usually given in powder form, dissolved in whiskey. 

CHLORETONE 

Chloretone is a white, crystalline powder which does not 
readily dissolve in water. It has an odor like camphor. 

ACTION 
Local action : Applied to the skin, it acts as an antiseptic. 

Internal Action 

Wlien it is taken internally, it soothes the stomach, and 
is rapidly absorbed into the blood. After absorption, it 
acts principally on the brain. It lessens the activity of 
the brain, producing sleep. By lessening the motor activi- 
ties of the brain, so that fewer impulses for motion are 
sent out from the brain, it lessens muscular contractions. 
Chloretone can produce general anaesthesia, but it is rarely 
used for this effect. 



372 MATERIA MEDICA 

Uses 

Cliloretone is used to produce sleep, very frequently to 
check an epileptic attack; and to lessen other convulsions, 
such as those occurring in tetanus, etc. It is occasionally 
used to check vomiting and seasickness. 

Preparations 
Chloretone 0.3-1.0 gm. grs. v-xv 

It is also used in a 1% solution. 

CHLORALOSE (not official) 

Chloralose is a white, crystalline powder, having a bitter 
taste. It is a compound of chloral and glucose (grape-sugar). 

It produces sleep ; its effects are similar to those of chloral, 
but it is not as reliable. 

Preparations 
Chloralose 0.3-0.6 gm. grs. v-x 

SULPHONAL 

Sulphonal or sulphonmethanum, is a white powder with- 
out any odor or taste. It does not dissolve readily in water. 
Chemically, it is a compound of sulphur and alcohol. 

Appearance of the Patient 

Within 1 to 6 hours after giving a dose of sulphonal, the 
patient falls asleep. The sleep is not very deep, but it lasts 
for about 8 to 10 hours, and sometimes longer. The pulse 
and breathing are usually not affected. On awakening, 
the patient often feels drowsy, complains of fullness in the 
head, and headache; and his gait may be a little unsteady. 
Occasionally, sulphonal is so slowly absorbed that it produces 
sleep the day following the night of its administration. 

ACTION 

Sulphonal resembles chloral in its effects, which appear 
more slowly, however. It produces no local effects. 



HYPNOTICS 373 

Internal Action 

No effects are produced by sulphonal in the mouth, stomach, 
or intestines. 

Action after Absorption 

Sulphonal is very slowly absorbed into the blood from the 
stomach, usually in about 1 to 6 hours. After absorption, 
it affects principally the brain. 

Action on the brain: It lessens the activity of the brain, 
producing sleep. 

Action on the respiration: In large doses, sulphonal often 
makes the breathing slow and shallow. 

It does not affect the heart action. 

Excretion 

Sulphonal is eliminated very slowly by the urine, as 
ethylsulphonic acid. Since it is excreted more slowly than 
it is absorbed, it often causes cumulative symptoms. 

Idiosyncrasies 

In some individuals, instead of sleep, the following symp- 
toms are produced : 

1. Nausea and vomiting. 

2. Excitement, 

3. Dizziness. 

4. Staggering. 

Poisonous Effects 

Acute Sulphonal Poisoning 

An overdose of sulphonal is rarely, if ever, fatal. It oc- 
casionally causes the following symptoms : 

1. Stupor. 

2. Slow, shallow breathing. 

Cumulative Sulphonal Poisoning 

Since sulphonal is more slowly excreted than it is absorbed, 
its prolonged use often causes the following alarming symp- 
toms, which may even result in death: 



374 MATERIA MEDICA 

1. Pink color of the urine, due to haematoporphyrin, a 
substance which is formed in the urine by the decomposition 
of the haemoglobin of the blood. 

2. Abdominal pain. 

3. Nausea and vomiting. 

4. Constipation. 

5. Weakness and unsteady gait. 

6. Mental confusion and hallucinations. 

7. Paralysis of various groups of muscles of the arms or 
legs. 

8. Suppressed urine; the urine often containing albumin. 

9. Collapse, which may result in death. 

Treatment 

1. Stop the drug. 

2. Saline diuretics are usually given. 

3. Move the bowels thoroughly. 

4. The collapse is usually treated with heart stimulants. 

Administration 

Sulphonal is best given in large quantities of milk or hot 
water several hours before bedtime. When given in this 
way, it acts more readily and is not so apt to cause unpleas- 
ant after effects. It may also be given in the form of a 
powder. 

Preparations 

Sulphonal 1.0-2.0 gm. grs. xv-xxx 

(Sulphonmethanum) 

VERONAL or BARBITAL 

Veronal, barbital, or diethyl barbituric acid, is a white 
crystalline powder, which has a slightly bitter taste. It is 
an artificial chemical substance. 

Appearance of the Patient 

About fifteen minutes to half an hour after an average 
dose of veronal is given, the patient usually falls asleep. 
The sleep resembles the normal sleep, and lasts for five to 



HYPNOTICS 375 

six hours. On awakening, the patient often complains 
of headache and dizziness. Occasionally, some patients 
have peculiar vivid dreams during the sleep. The pulse 
and breathing are not usually affected by veronal. It is a 
comparatively safe drug in small doses; but poisonous symp- 
toms (coma, slow pulse and shallow breathing) have occa- 
sionally followed its indiscriminate use, especially in old 
people. 

Administration 

Veronal is usually given in hot milk, about fifteen minutes 
to a half an hour before bedtime. 

Preparations 
Veronal or Barbital 0.3-1.0 gm. grs. v-xv 

(Veronalum) 
Diethyl Barbituric Acid 

It usually comes in tablets each containing 0.3 gm. (grs. v) 
each. 

Veronal Sodium (Medinal) 0.3 gm. grs. v 

(Sodium Diethyl Barbiturate) 

This is a sodium salt of veronal. It usually comes in 
tablets each containing 0.3 gm. (grs. v). It produces the 
same effects as veronal, but since it is more readily dissolved, 
it produces sleep more rapidly, and it can be given hypo- 
dermically or by rectum. 

Medinal Suppositories 

Each suppository contains 0.5 gm. (grs. vii|). 

TRIONAL 

Trional, or sulphonethylmethanum, is a powder having a 
bitter taste. It is an artificial chemical substance. 

Appearance of the Patient 

An average dose of trional usually produces natural sleep 
in about 15 minutes to an hour after it is given. The sleep 
lasts several hours and is accompanied by slight headache. 



376 MATERIA MEDICA 

ACTION 

The effects of trional are the same as those of sulphonal 
It is more readily absorbed, however, and it does not affect 
the heart or respiration as much. It occasionally causes the 
same cumulative poisonous symptoms as sulphonal. 

Administration 

Trional should be given about a half to one hour before 
bedtime in large quantities of hot milk or beer. 

Preparations 

Trional 1.0-2.0 gms. grs. xv-xxx 

(Sulphonethylmethanum) 

TETRONAL (not official) 

Tetronal is a white powder. Its effects are similar to those 
of trional and sulphonal. It is given in the same way, but 
it is not often used because it is more poisonous. 

Tetronal 1.0-2.0 gms. grs. xv-xxx 

BROMURAL 

This is an organic bromide salt (monobrom-isovaleryl 
urea). It is used to produce sleep in nervous patients. The 
sleep usually lasts for three to five hours. It usually comes 
in tablets, each containing 0.3 gm. (grs. v) each. 

PARALDEHYDE 

Paraldehyde is a colorless liquid having a peculiar, un- 
pleasant taste and odor. It is an oxidation product of 
alcohol. 

Appearance of the Patient 

A few minutes after an average dose of paraldehyde is 
given, the patient becomes drowsy and soon falls asleep. 
The sleep resembles the natural sleep, and lasts from about 
5 to 6 hours, but it is not as deep as that of chloral. The 



HYPNOTICS 377 

pulse and breathing are normal, and there are usually no 
after effects when the patient awakes. 

ACTION 

The action of paraldehyde is similar to that of chloral. 

Local action: Applied to the skin, it causes redness, pain, 
and occasionally forms blisters. On mucous membranes: It 
causes redness and increases the secretions. 

Internal Action 
In the mouth : Paraldehyde has a hot, burning taste. 
In the stomach and intestines: It increases the secretions; 
it often causes nausea and occasionally vomiting. 

Action after Absorption 

Paraldehyde is absorbed into the blood in a few minutes; 
through the mucous membrane of the stomach. After ab- 
sorption, it acts principally on the nervous system. 

Action on the brain: Paraldehyde lessens all the activi- 
ties of the brain, thereby producing sleep. Intense sensa- 
tions, such as pain, can still be appreciated, however, and 
these may keep the patient awake. 

The motor activities of the brain are also lessened, and the 
muscles are relaxed during sleep. 

Action on the spinal cord: Paraldehyde lessens all the 
activities of the spinal cord. All reflex action is lessened, 
go that the patient does not respond readily to external 
stimuli. 

Action on the heart and respiration: Paraldehyde does 
not affect the heart action, and in the doses that it is usually 
given, it does not affect the breathing. 

Effect on the temperature: Paraldehyde lowers the tem- 
perature by lessening the production of heat. 

Excretion 

Paraldehyde is excreted in the urine in a few hours. It 
is also eliminated by the expired air of the lungs. The 
breath often has the unpleasant odor of paraldehyde for a 
long time after it is given. 



378 MATERIA MEDICA 

Poisonous Effects 
Paraldehyde rarely, if ever, causes fatal symptoms. Over- 
doses often cause the following symptoms: 

1. Vomiting. 

2. Stupor. 

3. Slow, shallow breathing. 

4. Cyanosis. 

Prolonged use occasionally causes the following symptoms: 

1. Nausea, loss of appetite, and poor digestion. 

2. Ulcers in the nose. 

3. Various eruptions, principally areas of redness. (Ery- 
thema.) 

Uses 

Paraldehyde is used principally to produce sleep and to 
lessen muscular activity in epilepsy and delirium tremens. 

Administration 

In giving paraldehyde, it is important to disguise its taste, 
otherwise many patients cannot take it. It should be well 
diluted in water, brandy, syrup, or sweetened butter. It 
should be given a few minutes before bedtime. 

Paraldehyde is frequently given by the rectum especially 
in cases of delirium tremens. The best method is to dissolve 
the drug in boiled starch and then inject it into the rectum 
through a catheter. 

Preparations 

Paraldehyde 1.0-4.0 gms. grs. xv-5i 

(Paraldehydum) 

URETHANE (ETHYL CARBAMATE) 

Urethane or ethyl carbamate is a colorless, crystalline 
powder with a salty taste. It is an artificial chemical sub- 
stance. 

ACTION 

Urethane produces sleep in about 15 to 20 minutes, the 
sleep lasting for about 6 to 8 hours. 

Its effects are similar to those of paraldehyde, but it is 
not as reliable. It also increases the secretion of urine. 



HYPNOTICS 379 

It does not upset the stomach, however, and because it is 
readily dissolved, it may be given hypodermically. 

Preparations 

Urethane 1.0-4.0 gms. grs. xv-5i 

(Aethylis Carbamas) 

BROMOFORM 

Bromoform is a heavy colorless liquid with an odor and 
taste like that of chloroform. 

ACTION 

Bromoform acts like chloral, but its following principal 
effects appear more slowly: 

1. It produces sleep. 

2. It relieves pain. 

3. It lessens spasmodic contractions of the muscles. 

4. It is an antiseptic. 

It is principally used to relieve the spasmodic cough of 
whooping cough. 

Bromoform 0.2 c.c. m. iii 

AMYLENE HYDRATE (not official) 

Amylene hydrate is a colorless liquid, having an odor 
resembling that of camphor, and a pungent taste. 



ACTION 

It produces sleep; its effects are similar to those of chloral, 
but they are not as marked. It weakens the contractions of 
the heart and lessens all muscular contractions. 

It is best given in capsules or in water, flavored with 
Hcorice. 

Preparations 

Amylene Hydrate 2.0-4.0 c.c. m. xxx-gi 

(Amyleni Hydras) 



380 MATERIA MEDICA 

HYPNONE (not official) 

Hypnone is a colorless liquid formed from alcohol. It 
has a characteristic odor like that of oranges. It produces 
sleep but it is not very efficient. 

Hypnone 0.3-0.6 c.c. m. v-xv 

NEW AND NON-OFFICIAL HYPNOTICS 

HEDONAL 

Hedonal is a white crystalline powder with a cooling ef- 
fect in the mouth, like that of menthol. 

It produces sleep in about half an hour after it is given. 
It is a comparatively safe drug and produces no after effects. 
It occasionally increases the flow of urine. 

Preparations 
Hedonal 2.0 gms. grs. xxx 

It is given in powders or tablets. 

ISOPRAL 

Isopral is a white crystalline substance, with an aromatic 
taste and an odor resembling camphor. 

It produces sleep in about five minutes after it is given. 
Its effects are similar to those of chloral, but it is not as 
poisonous. It is said to be absorbed through the skin. 

Preparations 
Isopral 0.2-0.5 gm. grs. iii-viii 

NEURONAL 

Neiu-onal is a white crystalline substance having a bitter 
taste and odor resembling menthol. It produces sleep. 
Its effects resemble those of veronal, and it is given in the 
same way. 
Neuronal 0.3-2.0 gms. grs. v-xxx 



HYPNOTICS 381 

DORMIOL (AMYLENE CHLORAL) 

Dormiol or amylene chloral, is a colorless oily fluid with 
an odor like that of camphor. It is a compound of amylene 
hydrate and chloral. It produces sleep in about half an 
hour after it is given, with no after effects and it does not 
weaken the heart action. It is given principally to insane 
patients. 

Preparations 
Amylene Chloral 1.0-4.0 c.c. m. xv-5i 

Other Hypnotics 
Acetal 4.0-8.0 gm. 3i-ii 

Methylal 

These are chemical substances formed from alcohol, 
which are occasionally used to soothe the patient and to 
produce sleep. They act like sulphonal. 

Pellotine Hydrochloride 0.015-0.6 gm. grs. J-i 

This is an alkaloid from a Mexican plant used to produce 
sleep. 



CHAPTER XX 

ANTIPYRETICS 

Antipyretics are drugs which are used principally to lower 
the body temperature. 

Heat Production and Elimination 

The heat of the body is produced by the activity of the 
cells of the various organs of the body and by the contrac- 
tions of the muscles. 

When too much heat is produced, the excessive heat is 
eliminated in the following ways : 

1. By evaporation from the skin. The widened blood 
vessels of the skin contain more overheated blood, and the 
.-excessive heat evaporates from the skin. 

2. By increased perspiration. The perspiration is over- 
heated, and evaporation of the profuse perspiration elim- 
inates some of the heat. 

3. By the exhaled air. The expired air contains more 
heat; which is then eliminated. 

Heat Regulation 

The heat of the body is kept at a constant temperature, 
usually about 98.6 Fahrenheit, by means of a regulating 
center of gray matter in the brain (situated in the region 
of the corpora quadrigemina) . This is called the heat regu- 
lating center. This center keeps the body temperature 
always at 98.6 F. in the following ways: 

1. When the temperature is below 98.6 F., it is brought up 
to normal again by increased production of heat. This is done 
by means of increased muscular activity and greater activity 
of the various organs of the body. For example, after a 
convulsion or a chill, which is a series of muscular contrac- 
tions, the temperature usually rises several degrees. 

2. When the temperature is above 98.6 F., the tempera^ 
ture is lowered to normal again, by the increased elimination 
of heat. This is the result of increased sweating, dilatation 

382 



ANTIPYRETICS 383 

of the blood vessels of the skin and deeper and more rapid 
breathing. For example, when the weather is warm and 
not enough heat is lost, the temperature is kept normal by 
profuse sweating, flushed skin, and deeper breathing. 

In cold weather, when one is suddenly exposed to cold, 
wearing insufficient clothing, and is therefore constantly 
losing heat, more heat is immediately produced by the 
shivering which results. Shivering is a series of fine muscu- 
lar contractions or tremors, which produces enough heat to 
raise the body temperature to normal again. 

The sensitiveness of the heat regulating center varies in 
different individuals. It can be tested by observing how 
low the temperature must be reduced in any individual, 
before shivering is produced, or how high the temperature 
must be raised, before sweating occurs. 

Fever 

The bacterial poisons which cause most of the infectious 
diseases usually affect the heat regulating center in such a 
way, that it keeps the heat of the body regulated for a tem- 
perature higher than normal; perhaps 102 F. or 103 F., etc. 

We then have, in these infectious diseases, the higher 
temperature of the body as one of the symptoms of the 
disease. The usual temperature of that disease may be 
said to be its average temperature. If, however, the tem- 
perature rises several degrees above the usual, the excessive 
heat is eliminated by sweating, flushed skin, etc., just as in 
the normal individual, until the temperature is lowered again 
to the usual range for that particular disease. 

When the temperature is lower than the usual for the 
particular disease, more heat is produced; by shivering, or 
by a chill, until the temperature is raised nearer to the usual 
range. 

When, however, the infection is overcome, the heat regu- 
lating center is again set for its normal point : 98.6 F. 

Antipyretics 

Drugs lower the temperature in three different ways : 

1. By lessening the production of heat. This is accom- 



384 MATERIA MEDICA 

plished by such drugs as quinine, morphine, aconite, etc., 
which lessen the muscular and other activities of the body. 

2. By increasing the elimination of heat. Drugs hke pilo- 
carpine or morphine which produce sweating, and drugs 
which widen the blood vessels of the skin, such as the ni- 
trites, or the spirit of nitrous ether, reduce the temperature 
in this way. 

3. By setting the heat regulating center for a temperature 
nearer normal, so that the excessive heat is eliminated. 
When the temperature is normal, these drugs produce no 
effect. The analgesic antipyretics act in this way. 

ANALGESIC ANTIPYRETICS 

Coal Tar Antipyretics 

The drugs belonging to the coal tar group were originally 
used to lower temperature. They are now principally used 
to relieve nervousness, headache and pain. 

Source 

The analgesic antipyretics are all made by chemical 
methods from coal tar. This is a thick tarry liquid which 
remains as a sediment, together with other substances, 
after coal has been distilled in the manufacture of illuminat- 
ing gas. 

The effects of these substances are due to paramidophe- 
nol, which they form in the body. 

Appearance of the Patient 

(Antipyrine, Acetanilid, Phenacetine) 

About fifteen minutes to half an hour after an average 
dose of phenacetine is given, the patient is relieved of neural- 
gic pains or headache from which he may have been suffer- 
ing. If he has temperature, it may be reduced about three 
degrees or even to normal in several hours, accompanied by 
profuse sweating. The pulse and respiration are usually 
not very much affected. The skin is flushed and may be 
moist. 



ANTIPYRETICS 385 



ACTION 



Applied to the skin or mucous membranes: Antipyrine 
relieves pain and acts as an antiseptic. It checks bleeding 
by contracting the small blood vessesls. Acetanilid is 
slightly irritating. Phenacetine has no local effect. 

Internal Action 

In the mouth the coal tar drugs have a bitter taste. 

In the stomach and intestine there are no effects except 
nausea and vomiting which occur occasionally in fever pa- 
tients. 

Action after Absorption 

The analgesic antipyretics are absorbed into the blood 
in about a half hour. Here a simpler chemical substance 
paramidophenol is formed from them which is responsible 
for the effects of the drug. 

After absorption they affect principally the brain, the 
temperature, the blood and the circulation. 

Action on the brain: The analgesic antipyretics are sooth- 
ing to the brain. They relieve neuralgic pains, nervous 
headache and irritability, making the patient calm and quiet. 
Acetanilid frequently produces light sleep. 

Action on the temperature: The analgesic antipyretics 
lower the temperature in fevers several degrees or even to 
normal, by setting the heat regulating center for a lower 
temperature. It usually remains down for several hours. 
The normal temperature i^ not affected. 

Action on the blood: Acetanilid and phenacetine form 
methaemoglobin in the blood. This does not readily com- 
bine with oxygen like ordinary haemoglobin, and accounts 
for the cyanosis that results from large doses. 

Action on the circulation: The pulse is somewhat faster 
at first, but large doses make it slow and weak by lessening 
the force of the contractions of the heart muscle. When 
given together with caffeire, the tendency to cause a 
weak and slow pulse is increased. 

Action on the respiration: The breathing is somewhat 
more rapid at first but it may become slower. 



386 MATERIA MEDICA 

Action on the secretory glands : The secretion of sweat is 
increased. 

Excretion 
The analgesic antipyretics are slowly eliminated from the 
body by the kidneys, usually in about twelve to twenty-four 
hours. 

Idiosyncrasies 

In some individuals, such as those that are anaemic, or 
those weakened by prolonged illness, the following unusual 
symptoms occasionally occur : 

1. Skin eruptions: redness and itching, often swelling of 
the face and eyelids, which may last for several days. 

2. Nausea and vomiting. 

3. Cyanosis (especially after acetanilid and phenacetine). 

4. Collapse. 

5. Dizziness. 

Poisonous Symptoms 

The symptoms of poisoning may follow a single overdose 
in which case they appear suddenly. Usually however, they 
result from the continued use of some patent headache pow- 
der for the rehef of headache. 

Overdoses of analgesic antipyretics cause the following 
symptoms : 

1. Cyanosis (blue color of the face and hands). 

2. Shortness of breath. 

3. Slow weak pulse. 

The cyanosis is not as marked after antipyrine. 
With larger doses, in addition to these symptoms, there 
may be the following : 

4. Subnormal temperature. 

5. Muscular twitchings. 

6. Collapse, 

7. Stupor. 

Treatment 
Usually, stopping the drug is sufficient. In severe cases 
the following procedures are carried out : 
1. Keep the patient quiet. 



ANTIPYRETICS 387 

2. Wash out the stomach. 

3. Give demulcent drinks (oils, acacia, etc.). 

4. Give oxygen to reheve the cyanosis. 

5. Atropine and other stimulants are given. 

Habit Formation 

Many nervous patients get into the habit of taking various 
headache powders for the relief of nervousness and headache. 
The habit is most pernicious; not only because of the danger 
of poisonous symptoms developing, but because of the inter- 
ference with the general health. The nurse should therefore 
discourage the use of these remedies; and only give them 
when other milder measures are of no avail. Continued use 
of the coal tar drugs causes the following symptoms : 

1. Digestive disturbances, 

2. Nervousness. 

3. Restlessness. 

4. Sleeplessness. 

The last three symptoms occur especially when the drugs 
are suddenly discontinued. 

Administration 

The antipyretics are best given between meals in wine, 
iced brandy, syrup, or milk. Thus the rapid formation 
of paramidophenol is prevented and poisonous symptoms 
are not so apt to appear. It was formerly customary to 
give these substances together with caffeine, but it has 
now been proven that this increases the tendency to weaken 
the heart action. 

The coal tar antipyretics or their derivatives should not 
therefore be given together with caffeine. Sodium bicar- 
bonate, however, does tend to lessen the weakening action 
on the heart. 

Antipyrine is occasionally given hypodermically. It 
should then be injected deep into the muscles, to prevent 
the formation of abscesses. 



388 MATERIA MEDICA 

PREPARATIONS 

ANTIPYRINE 

Antipyrine is a white crystalline powder which is readily 
dissolved in water. It resembles an alkaloid in its chemical 
properties, combining with acids to form salts. 

Antipyrine 0.3-1.3 gms grs v~xx 

(Antipyrina) 

Antipyrine Salicylate (Salipvrin) 0.3-2.0 gms. grs. v-xxx 
(Antipyrinae Salicylas) 

(Not official) 

This is a combination of antipyrine with salicylic acid. 
It is said to relieve rheumatic pains more efficiently than 
either of its constituents alone. 

Ferropyrine (not official) 0.3-1.0 gm. grs. v-xv 

(Antipyrina cum Ferro) 

This is a compound of antipyrine and iron chloride which 
is said to check bleeding. 

Tussol (not official) 
(Antipyrine mandelate) 

This is used in doses of 0.03-0.3 gm. (grs. J-v), to 
lessen nervousness. 

ACETANILID (ANTIFEBRINE) 

Acetanilid is a white crystalline powder formed by the 
action of glacial acetic acid, on anilin, a chemical substance 
which is an ingredient of many dyes. It is a neutral sub- 
stance and does not form salts with acids. Chemically it is 
phenylacetamid. It is not readily dissolved in water. 

Acetanilid 0.06-0.6 gm. grs. i-x 

(Acetanilidum) 

Compound Acetanilid Powder 0.5 gm. grs. viii 

(Pulvis Acetanilidi Compositus) 



ANTIPYRETICS 389 

This consists of 7 parts of acetanilid, 1 part of caffeine 
and 2 parts of sodium bicarbonate. 



ACETPHENETIDIN (PHENACETINE) 

Phenacetine or acetphenetidin, is a white crystalHne 
powder made from coal tar. 

Phenacetine 0.3-1.0 gm. grs. v-xv 

(Acetphenetidinum) 

Thermodin or Phenacetine Ure- 

thane (not official) 0.3-1.0 gm. grs. v-xv 

(Acetylparethoxy) 

This is a compound of phenacetine and urethane. Its 
effects are similar to those of phenacetine. 



NEW AND NON-OFFICIAL ANTIPYRETICS 

There are a large number of drugs made from coal tar, 
which are frequently used as antipyretics, but they are not 
official.^ Many of them are said to be safer than either anti- 
pyrine, acetanilid, or phenacetine. Only the most important 
ones are given here, and new ones are constantly being made. 

Many patent headache powders contain coal tar antipy- 
retics, and these frequently produce poisonous effects from 
continued use. 

PYRAMIDON 

Pyramidon is an artificial chemical substance which acts 
like antipyrine. It relieves nervous pains and headaches. 
It reduces temperature slowly, but the temperature stays 
down longer. In large doses it weakens the heart action. 

Preparations 

Pyramidon 0.06-0.4 gm. grs. i -vi 

(Dimethylaminoantipyrina) 

Pyramidon Acid Camphorate 0.6 -1.0 gm. grs. x -xv 

Pyramidon Neutral Camphorate 0.5 -0.8 gm. grs. viii-xii 



390 MATERIA MEDICA 

The last two preparations are said to be safer than pyrami- 
don. 
Triphenin 0.3-1.0 gm. grs. v-xv 

This is a derivative of phenacetine. It acts hke phenace- 
tine, but its effects are slow and milder. 

PHENOCOLL 

Phenocoll is an artificial chemical substance which acts 
like phenacetine, but it is said to be safer. It has been used 
as a substitute for quinine, in malaria. 



Preparations 
Phenocoll Hydrochloride 0.3-1.3 gm. grs. v -xx 

Phenocoll Salicylate 1.0-2.0 gms. grs. xv-xxx 

This combines the effect of phenocoll with salicylic acid, 
and is used to reheve rheumatic pains. 

Salocoll 0.5-1.0 gm. grs. viii-xv 

The following less important unofficial antipyretics are 
occasionally used. Their effects are similar to those of the 
other antipyretics. 

Thalline 0.2 -0.5 gm. grs. iii-viii 

Exalgine 0.06-0.6 gm. grs. i -x 

This resembles acetanilid in its action, but it is said to be 
safer. It occasionally causes dizziness, twitching and weak- 
ness of the eyelids. 

Lactophenine 0.5-1.0 gm. grs. viii-xv 

Thermodine 0.5-1.0 gm. grs. viii-xv 

Neurodine 0.5-1.0 gm. grs. viii-xv 

Malakine 

Saliphen 0.5-1.0 gm. grs. viii-xv 

Salophen ^ 

These substances decompose in the body, forming salicylic 
acid. They therefore relieve rheumatic pains, besides 
lowering the temperature. Malakine occasionally produces 
sweating. 



ANTIPYRETICS 



391 



Antikamnia 
Antinervine 
(Consisting of ammonium 

bromide, salicylic acid 

and acetanilid.) 
Benzanilide 
Exodyne 
Phenolide 
Analgen 
Hydracetine 
lodophenine 
Methacetine 
Thymacetine 
Asaprol 



0.6-1.0 gm. grs. x-xv 
These are proprietary prepara- 
tions which produce the same ef- 
fects as acetanilid. 



0.2-0.6 gm grs. iii-x 
These are proprietary prepara- 
tions which act like phenacetine. 
0.3-2.0 gms. grs. v-xxx 



This relieves pain, reduces temperature, checks bleeding, 
lessens nervousness, produces sleep, and increases the flow 
of urine. It occasionally increases the perspiration. It is 
often used as lotions of 1-5% solutions. 

Migrainin 1.0 gm. grs. xv 

This consists of antipyrine, caffeine and citric acid. 



USES OF THE ANTIPYRETICS 

The antipyretics were originally used principally to re- 
duce fever. Most of them weaken the heart action, and 
form methaemoglobin. They are therefore, not used for 
this effect as much as they formerly were. Cold baths, cold 
sponges, etc., have taken their place. These are preferable 
to reduce fever, as they do not affect the heart or blood. 

The antipyretics are very useful drugs, however, and are 
now principally used to relieve indefinite pains and nervous 
headaches. 

Better results are often obtained by combining small 
doses of several of these drugs, instead of giving an average 
dose of a single one. They are best given in whiskey or with 
sodium bicarbonate. i 

They should not be given together with caffeine since 
this increases the tendency to weaken the heart action. 



CHAPTER XXI 

ANTISPASMODICS 

(Antihysterics) 

Antispasmodics or Antihysterics are drugs which reheve 
^' nervousness." Nervousness is a group of symptoms which 
occur in hysteria and neurasthenia. In these conditions 
patients are more susceptible to all sensory impulses, and 
they are more emotional. They are usually restless, they 
lack concentration, and suffer from sleeplessness. They 
are more irritable and have all sorts of indefinite pains and 
aches. These symptoms are relieved by many of the drugs 
in this group in an unknown way; probably by suggestion. 
Most of the substances have a very strong unpleasant odor, 
which makes the patients think they are taking a very effi- 
cient remedy and the symptoms therefore improve. 

Because these drugs often relieve the nervous twitchings 
of the muscles, as well as the other symptoms of neurasthenia 
or hysteria, they are often called antispasmodics. 

VALERIAN 

Valerian is obtained from the roots and underground 
stems of the Valeriana officinalis, a European plant. Its 
active principle is a volatile oil which has a very unpleasant 
odor, especially when it is old. It also contains valerianic 
acid and other substances. It was formerly used in England 
as a perfume. 

Appearance of the Patient 

After a preparation of valerian is given, the patient be- 
comes calm and quiet and his nervousness is lessened. 

ACTION 

Valerian has no local action. 

When given internally, it produces the following effects: 
1. It has an unpleasant taste and odor, it checks the for- 
mation and aids in the expulsion of gas from the stomach 
(carminative action). 

392 



ANTISPASMODICS 393 

2. It allays nervousness, and makes the patient calm and 
quiet; probably because of its unpleasant taste and odor. 

3. It makes the pulse a Httle faster and stronger. 

4. It is said to increase the sweat and the urine. 



Preparations 

Fluidextract of Valerian 2.0-4.0 c.c. 5 ^i 

(Fluidextractum Valerianae) 

Tincture of Valerian 4.0-12.0 c.c. 5i -iii 

(Tinctura Valerianae) 

Ammoniated Tincture of Valerian 4.0-12.0 c.c. 5 i -iii 
(Tinctura Valerianae Ammoniata) 

New and Non-official Preparations 

Valyl 0.12 gm. grs. ii 

(Valeryldiethylamidum) 

This usually comes in '^ pearls," two or three of which are 
given after meals. 

Validol 0.6-1.0 c.c. m. x-xv 

(Menthyl Valerianate) 

This is a compound of menthol and valerianic acid. It 
acts like valerian, but is much more pleasant to the taste 
and has a marked carminative action. It is best given in 
10 to 15 drop doses on a lump of sugar. 

Validol Camphorate 0.6-1.0 c.c. m. x-xv 

This acts like validol, but because of the camphor which 
it contains, it is somewhat strengthening to the heart, and it 
relieves pain when locally applied. 

Bornyval 0.25-0.75 c.c. m. iv-xii 

This is Borneol isovalerate, which forms a large part of 
the oil of valerian, the active principle of valerian. 

Brovalol 0.25-0.75 c.c. m. iv-xii 

Gynoval 0.25-0.5 gm. grs. iv-viii 

This acts like valerian but it is more pleasant to take. 



394 MATERIA MEDIC A 

COMPOUND SPIRITS OF ETHER (HOFFMAN'S ANODYNE) 

Compound spirits of ether, or Hoffman's anodyne, is 
used principally to lessen nervousness and calm the patient. 
It also checks the formation of gas in the stomach. Its 
effect is due principally to the ethereal oil, or oil of wine, 
which it contains. This is a substance which is formed by 
distilling alcohol with sulphuric acid and then diluting the 
resulting fluid with ether. 

Preparations 

Compound Spirits of Ether 2.0-4.0 c.c. 5 |-i 

(Spiritus Aetheris Compositus) 
(Hoffman's Anodyne) 

The following preparations are occasionally used to relieve 
nervousness and to make the patient calm and quiet. 
Acetic Ether 1.0 c.c. m. xv 

(Aether Aceticus) 

This resembles ether, but it does not readily evaporate. 

MONOBROMATED CAMPHOR (CAMPHORA MONOBRO= 

MATA) 

This resembles camphor in its action. It is given in doses 
of 0.3-1.0 gm. (grs. v-xv). 

Camphor itself is also used to lessen nervousness and quiet 
the patient. 

MUSK (MOSCHUS) 

Musk is the dried secretion of the glands situated in front 
of the prepuce of the Moschus moschiferus, or the musk 
deer of Thibet. It is a dark brown substance, with a very 
strong characteristic odor. 

ACTION 

Owing to the difficulty of obtaining a reliable preparation, 
musk often produces no effects. If the preparation is a 
good one, it produces the following effects: 

1. It relieves nervousness and calms and quiets the patient. 



ANTISPASMODICS 395 

2. It is said to make the pulse stronger and faster. 

3. It often relieves hiccough. 

Larger doses have occasionally caused headache, dizziness, 
confusion, and muscular twitchings, followed by sleep. 

Preparations 

Musk (powder) 0.5-1.0 gm. grs. viii-xv 

(Moschus) 

Tincture of Musk ( 4.0-8.0 c.c. 5i-ii 

(Tinctura Moschi) 

HUMULUS LUPULUS (HOPS) 

Hops are the dried cones which consist of scales, of the 
Humulus lupulus, or hop vine, a plant growing in England, 
northern Europe, and the United States. At the base of 
the scales, there is a yellow powder called lupulin. The 
active principle of hops is a volatile oil. 

ACTION 

When locally applied, hops reheves pain and causes redness 
of the skin. 

When taken internally, it produces the following effects: 

1. It increases the appetite and aids digestion. 

2. It is soothing to the brain and lessens nervousness, 
and may even produce light sleep. 

3. It contracts mucous membranes. 

4. It is said to increase the perspiration. 

Administration 

Hops are usually applied in the form of bags containing 
the crude hops. These are soaked in v/ater, wrung out, and 
applied locally, or they may be heated and used dry. 

Pillows made from hops are used to induce sleep. 

Preparations 

Lupulin (powder) 0.3-1.2 gm. grs. v-xx 

(Lupulinum) 



398 MATERIA MEDICA 

Fluidextract of Lupulin 2.0-8.0 c.c. 5i-ii 

(Fluidextractum Lupulini) 

Oleoresiii of LupuUn 0.1-0.3 gm. grs. i|-v 

(Oleoresina Lupulini) 

SUMBUL 

Sumbul or vegetable musk is obtained from the root and 
underground stems of the Ferula sumbul, a plant which is 
very little known. Its active principle is a volatile oil. 

It IS used principally to allay nervousness and make ^lie 
patient calm and quiet. It may be given in large doses. 

Preparations 

Extract of Sumbul 0.25 gm. grs. iv 

(Extractum Sumbul) 

Fluidextract of Sumbul 2.0 c.c. m. xxx 

(Fluidextractum Sumbul) 

CYPRIPEDIUM 

Cypripedium is obtained from the roots and underground 
stems of Cypripedium pubescens or ladies' slipper, and from 
Cypripedium parvifiorum or moccasin plant, two American 
plants. The active principle of these plants is a volatile oil. 

It relieves nervousness and quiets the patient. It has 
been used as a substitute for valerian. 

Fluidextract of Cypripedium 1.0-2.0 c.c. m. xv-xxx 
(Fluidextractum Cypripedii) 

SCUTTELARIA 

Scuttelaria is obtained from the Scuttelaria lateriflora 
or skull cap, an American plant. It relieves nervousness 
and quiets the patient. 

Fluidextract of Scuttelarium 4.0 c.c. 3 i 

(Fluidextractum Scuttelariae) 



PART VI— DRUGS WHICH ACT UPON THE PERIPHERAL 
NERVE ENDINGS 

CHAPTER XXII 

STIMULANTS OF NERVE ENDINGS 

Physiology of Nerve Endings 

Many drugs principally affect the nerve endings; which 
are small microscopic structures that connect the termina- 
tions of the nerve fibers with the various tissues and organs 
of the body. The function of the nerve endings is to receive 
impulses for transmission to the spinal cord and brain when 
the nerve is a sensory or afferent nerve. When the nerve 
is a motor or secretory (efferent) nerve, its nerve endings 
transmit the impulses to the muscles or glands in which 
they are situated. 

When the nerve endings are stimulated, the effects vary 
according to the kind of nerve; whether it is a sensory (af- 
ferent) nerve or a motor or secretory (efferent) nerve. 

Stimulation of secretory nerve endings increases the secre- 
tion of the glands in which these nerve endings are situated, 
because the nerve endings then receive impulses for secre- 
tion more readily. 

Stimulation of motor nerve endings increases the contrac- 
tions of the various muscles in which the nerve endings are 
thus affected, because impulses for contraction of these mus- 
cles are received more readily. 

Stimulation of sensory nerve endings increases the appre- 
ciation of the sensations carried by these nerves; thus, an 
ordinary sensation of touch may be appreciated as a tingling 
sensation. Practically, no drugs are used to produce this 
effect. 

When the sensory nerve endings are stimulated, reflex 

action is increased, because impulses to the spinal cord are 

started more readily. 

397 



398 MATERIA MEDICA 

Depression of Nerve Endings 

When the nerve endings are depressed, the following are 
the effects on the secretory, motor (efferent) and sensory 
(afferent) nerves. 

Depression of secretory nerve endings lessens the secretion 
of the glands in which the nerve endings have been affected, 
because impulses for secretion are not so readily received. 

Depression of motor nerve endings lessens the contractions 
of the muscles in which the nerve endings have been affected, 
because impulses for the contraction of these muscles are not 
as readily received. 

Depression of the sensory nerve endings lessens the ap- 
preciation of the various sensations, which are then not as 
readily appreciated. Numbness and insensibility to pain 
are produced when the sensory nerve endings of the skin 
are thus affected. 

Since impulses are not able to be readily started when 
sensory nerve endings are depressed, substances which pro- 
duce this effect also lessen reflex action. 

The drugs that lessen the action of the sensory nerve end- 
ings are used principally as local anaesthetics. 

SECRETORY STIMULANTS 

Secretory stimulants are drugs whose principal action is 
to increase the secretions of the secretory glands. Prac- 
tically these substances are used only to increase the secre- 
tion of sweat. 

DIAPHORETICS 

Diaphoretics are drugs used principally to increase the 
secretion of sweat. 

PILOCARPUS OR JABORANDI 

Pilocarpus or jaborandi is obtained from the leaves of the 
Pilocarpus jaborandi, or Pilocarpus microphyllus, a Brazilian 
shrub. Its active principle is an alkaloid, pilocarpine. The 
preparations of pilocarpine, the alkaloid, are principally used. 
It has an odor resembling hay. 



STIMULANTS OF NERVE ENDINGS 399 

Appearance of the Patient 

About five to fifteen minutes after a dose of pilocarpine 
is given, all the secretions are increased. The patient sweats 
profusely, there is a profuse flow of saliva, of tears, and of 
mucus from the nose, mouth and bronchi. The face is 
flushed, the pupils are contracted, and there is difficulty in 
seeing distant objects. The breathing is faster, and the pulse 
is somewhat more rapid and weaker. Later there may be 
diarrhoea. 

ACTION 

Local action : Applied to the skin, pilocarpine produces no 
effects, but it is readily absorbed from such local applica- 
tions. It frequently increases the growth of hair on the 
scalp, whether it is applied locally or given internally. This 
is probably due to the increase in the secretions of the scalp. 
The hair is usually lighter in color and grows in patches. 
On mucous membranes : It is readily absorbed, but does not 
affect them locally. For example, the application of a 
drop of pilocarpine solution causes only general or systemic 
effects. 

Internal Action 

In the mouth: Pilocarpine has a bitter taste. 

In the stomach: It increases the secretion of the mucous 
membrane, and greatly increases the peristalsis of the stom- 
ach. In large doses it often causes nausea and vomiting. 

In the intestines : Pilocarpine increases the secretion of the 
mucous membrane and the peristaltic contractions of the 
muscle wall. Frequent movements of the bowels therefore 
often result. 

Action after Absorption 

Pilocarpine is very rapidly absorbed into the blood from 
the stomach, and from all the mucous membranes upon 
which it is applied; usually in about fifteen minutes. After 
absorption it affects principally the secretory glands, the 
involuntary muscles, the pupils, the heart and respiration. 



400 MATERIA MEDICA 

Action on the secretory glands: This is the most important 
effect of pilocarpine. It increases the secretions of all the 
secretory glands, except those of the breasts, the hver, and 
the kidneys. 

The secretion of the sweat glands is greatly increased 
(diaphoretic action). It is used principally to produce this 
effect. The great activity of the sweat glands makes the 
skin very red. About §x-xv of sweat are secreted after 
one dose of pilocarpine, and the effect lasts for about three 
to five horn's. 

There is usually a profuse secretion of saliva, of tears, of 
mucus from the nose, and bronchi. The secretion of the 
mucous membrane of the stomach and intestines is also 
increased. The secretion of milk, bile and urine, however, 
is not affected. 

The effect on the secretory glands is the result of in- 
creased activity of the nerve endings for secretion in the 
various glands of the body. These nerve endings be- 
come more sensitive and receive impulses for secretion 
more readily. 

Action on the involuntary muscles: In large doses pilo- 
carpine increases the contractions of all the involuntary 
muscles, by increasing the activity of the nerve endings in 
these muscles. These nerve endings then become more sensi- 
tive and receive impulses for the contraction of the muscles 
more readily. 

The contractions of the involuntary muscles of the stom- 
ach and intestines (peristalsis) are increased. The contrac- 
tions of the involuntary muscles of the bronchi which result 
from pilocarpine, make the bronchi narrower, so that the 
patient must breathe faster and deeper to inhale a sufficient 
amount of air. The contractions of the involuntary muscles 
of the bladder, often cause frequent urination accompanied 
by straining. 

The spleen and uterus are also contracted by pilocarpine. 

Action on the pupil: Pilocarpine contracts the pupil. The 
effect on the pupil is due to the increased contractions of 
the involuntary circular muscles of the iris of the eye, which 
make the pupil smaller. The contractions of the ciliary 



STIMULANTS OF NERVE ENDINGS 401 

muscle of the eye, make the len5; more convex, so that the 
patient sees only near objects, and has groat difficulty in 
seeing distant ones. Pilocarpine also makes the eyeball 
softer, by causing a free circulation of fluid from the pos- 
terior to the anterior chamber of the eyeball. It is often 
used to produce this effect in glaucoma, a disease in which the 
eyeball becomes hardened and which often causes blindness. 

Action on the circulation : In large doses pilocarpine makes 
the heart beat slower and weaker. The pulse is therefore 
slow and weak. It makes the nerve endings in the heart, of 
the Vagus nerve, more sensitive; so that these nerve endings 
receive impulses to slow the heart more readily. The pulse 
may be somewhat stronger and faster for a few minutes. 
Poisonous doses dilate the small blood vessels. 

Action on the respiration: The breathing becomes deeper 
and faster. This is due to the narrow bronchi which result 
from the contractions of their involuntary muscles, and the 
weakened heart action; as a result of which the blood ac- 
cumulates in the lungs. The patient then has to breathe 
faster and deeper (asthmatic breathing) to get a sufficient 
amount of air in the lungs. Poisonous doses lessen the action 
of the respiratory center, thus making the breathing slow 
and shallow. 

Effect on temperature: The profuse sweating which re- 
sults from pilocarpine, usually lowers the temperature 
shghtly. 

Excretion 

Pilocarpine is excreted mainly by the kidneys and sweat. 
It begins to be eliminated in about an hour, and is entirely 
excreted in about twenty -four hours. 

Dangers in the Use of Pilocarpine 

Pilocarpine is a very efficient drug; but its use is limited 
by some of the following effects, which are often injurious 
to the patient. 

1. The slow and weak pulse. 

2. The profuse secretion of mucus in the bronchi fills 
up the lungs with mucus, and the contractions of the in* 



402 MATERIA MEDICA 

voluntary muscles of bronchi make them narrower. The 
mucus is then expelled with difficulty, and the lungs fill 
up with fluid. This condition is known as oedema of the 
lungs. The patient is then said to ' ' drown '' in his own sweat. 
3. Patients often feel very weak and chilly after pilo« 
carpine. 

Poisonous Effects 

Since pilocarpine is rapidly excreted, only acute poisoning 
occurs, usually from an overdose. 

Symptoms 

1. Great weakness. 

2. Profuse secretion of saliva. 

3. Profuse perspiration and flow of tears. 

4. Occasionally, nausea, vomiting, abdominal pain and 
profuse diarrhoea, with watery stools. 

5. Slow, irregular, weak pulse. 

6. Rapid, difficult breathing, accompanied by ^'rales" 
(gurgling sounds in the lungs, due to the accumulation of 
mucus) . 

7. Contracted pupils. 

8. Occasionally, dizziness, slight delirium, and twitchings 
of the muscles. 

The breathing finally becomes slow and shallow, the pa- 
tient complains of great weakness, and death results from 
failure of the respiration. Consciousness remains to the end. 

Treatment 

1. Atropine is given as an antidote. This paralyzes the 
nerve endings, which have been made more active by pilo- 
carpine and neutralizes its effects. 

2. Give artificial respiration if the breathing is slow and 
shallow. 

3. Heart stimulants such as caffeine or camphor are 
usually given. 

Uses 

1. Pilocarpine is used principally to increase the sweat; 
in cases of nephritis, when the patient secretes very little 



STIMULANTS OF NERVE ENDINGS 403 

urine, and to remove fluid from the tissues (oedema). To 
avoid unpleasant effects from pilocarpine, the patient should 
be wrapped up in blankets and kept warm. 

2. It is often given as a hair tonic, by local applica- 
tions. The hair is the secretion of the hair follicle, and the 
effect is probably due to the increased secretion of this, as 
well as of the other secretory glands. 

3. It is often given to overcome dizziness resulting from 
lessened secretion in the labyrinth of the ear. 

Preparations 

Fluidextract of Pilocarpus 0.5 -2.0 c.c. m. viii-xxx 

(Fluidextractum Pilocarpi) 

Pilocarpine 

Pilocarpine Hydrochloride 0.003-0.03 gm. gr. gV^i 

(Pilocarpinae Hydrochloridum) 

Pilocarpine Nitrate 0.003-0.03 gm. gr. gVi 

(Pilocarpinae Nitras) 

MUSCARINE 

Muscarine is an alkaloid, which is the poisonous principle 
of various poisonous mushrooms. It produces effects ex- 
actly like those of pilocarpine. The symptoms resulting from 
eating poisonous mushrooms are the same as those of pilo- 
carpine poisoning. 

EUPATORIUM (THOROUGHWORT) 

Eupatorium is obtained from the leaves and flowers of 
the Eupatorium perfoliatum, boneset or thoroughwort. 

It is used principally to increase the perspiration. It is 
given as an infusion, very hot; a tumblerful at a time. The 
patient should be in bed, warmly covered. 

OTHER DIAPHORETICS 

There are a number of drugs which increase the secretion 
of the secretory glands, especially the sweat glands, but they 



404 MATERIA MEDICA 

produce other more important effects. The most common 
ones are the following: 

Ipecac (especially in the form of Dover's powder) 

Antimony 

Aconite 

Veratnim Viride 

Spiritus Aetheris Nitrosi (sweet spirits of niter) 

and m.any of the sahne diuretics, such as, 

Potassium Citrate 

Solution of Ammonium Acetate 

Spirit of Mindererus 

Most of the salicylic acid preparations also increase the 
perspiration. 

Eunatrol (non-official) 1.0 gm. grs. xv 

This is sodium oleate. It is said to increase the flow of 
bHe, 

DRUGS WHICH INCREASE THE CONTRACTIONS OF THE 
INVOLUNTARY MUSCLES 

(Stimulants of the Motor Nerve Endings) 

PHYSOSTIGMA AND ESERINE 

Physostigm_a is obtained from the Physostigmine veneno- 
sum, the calabar bean, or ordeal bean. It is a large bean, 
growing on a vine, principally in Calabar, on the western 
coast of Africa. 

Its active principle is an alkaloid, eserine, or physostigmine. 
It contains two other alkaloids, calabarine, and eseridine. 

A paste made from the calabar bean has been used for 
generations by the natives of the Western Coast of Africa, 
as a test in the trials by ordeal for various crimes; such as 
witchcraft, etc. The accused individual was forced to eat 
the paste; if he died, he was guilty, otherwise he was con- 
sidered innocent! 

Appearance of the Patient 
About fifteen minutes after giving a dose of eserine, the 



STIMULANTS OF NERVE ENDINGS 405 

patient usually complains of cramp-like pains in the abdo- 
men and slight weakness. He often feels somewhat nau- 
seated and the bowels move very freely, the stools being 
quite fluid. There is usually a profuse secretion of saHva 
and perspiration. 

The pulse is slow and weak, and the breathing is at first 
somewhat rapid and deep, but later it becomes slow and 
shallow. The pupils are contracted, and the patient is un- 
able to see distant objects clearly. He usually complains of 
weakness. 

ACTION 

The action of physostigma is due to the eserine which it 
contains. This is the preparation commonly used. The ef- 
fects of eserine are quite similar to those of pilocarpine. 
They are due to stimulation of the nerve endings. 

Local action: Applied to the skin, or mucous membranes, 
it produces no effects, but the drug is readily absorbed from 
mucous membranes. 

Internal Action 

In the mouth : No effects are produced. 

In the stomach and intestines : It markedly increases the 
secretions of the mucous membranes and the peristalsis, much 
more so than pilocarpine does. Cramp-like abdominal pains 
with frequent fluid stools result. 

Action after Absorption 

Eserine is very rapidly absorbed into the blood from the 
stomach, in about fifteen minutes to a half hour. After 
absorption it affects principally the involuntary muscles, 
the pupils, the secretory glands, the circulation and the res- 
piration. 

Action on the involxmtary muscles: Eserine increases the 
contractions of all the involuntary muscles, by increasing 
the activity of the nerve endings in the muscle wall. These 
nerve endings then become more sensitive, and receive 
impulses for contraction of the muscles more readily. 

The muscles of the intestines are particularly affected, the 
peristalsis is very much increased, and frequent fluid move- 



406 MATERIA MEDICA 

ments of the bowels result. The contractions of the muscles 
of the ureter, bladder and uterus, are also increased. 

Action on the pupils: It contracts the pupil if apphed 
locally to the conjunctiva, or when given internally. It 
makes the nerve endings of the circular muscles of the iris 
more sensitive, so that impulses for their contractions are 
more readily received. 

Eserine also contracts the cihary muscle of the eye, a 
muscle which holds the lens in place. The contraction of this 
muscle makes the lens more convex, so that the patient is 
unable to see distant objects clearly. It also causes a free 
circulation of fluid from the posterior to the anterior cham- 
ber of the eye, thereby making the eyeball softer. Eserine 
is often used to produce this effect in glaucoma, a disease 
in which the eyeball becomes hardened, and which often 
results in blindness. 

Action on the secretory glands: Eserine increases the 
secretion of all the secretory glands, by making their 
nerve endings more sensitive to receive impulses for secre- 
tion. 

The secretion of saliva, mucus from the nose and bronchi; 
the tears, perspiration, the pancreatic, the stomach and 
intestinal secretions are all increased. This effect is not 
very marked, however, because of the contractions of the 
blood vessels in the glands. These contractions tend to 
neutralize the stimulation by limiting the blood supply of 
the glands. 

Action on the circulation: 

On the heart: eserine makes the heart beat slower, by 
making the nerve endings of the Vagus nerves in the heart 
more sensitive to receive impulses for slowing the heart. 

On the blood vessels: The contraction of the involun- 
tary muscle fibers in the walls of the blood vessels makes 
the blood vessels narrower. The blood pressure is thus 
raised; usually, however, this effect is not very marked. The 
pulse of eserine is therefore slow and strong. 

Action on the respiration: The breathing is at first rapid 
and deep, because of the narrow bronchial tubes. Later, it 
becomes slow and shallow, as a result of lessened activity of 



STIMULANTS OF NERVE ENDINGS 407 

the respiratory center in the medulla, so that fewer impulses 
for breathing are sent out. 

Action on the spinal cord: It lessens the reflex action of 
the spinal cord and medulla. 

Excretion 
Eserine is very rapidly eliminated from the body by the 
urine and by all the secretions. It begins to be excreted in 
a few minutes, and is entirely eliminated in a few hours. 

Poisonous Effects 
Since eserine is very rapidly excreted, only acute poisoning 
occurs; usually from an overdose of the drug, given hypoder- 
mically or dropped into the eye. 

Symptoms 

1. Abdominal cramps. 

2. Nausea and vomiting. 

3. Diarrhoea, with frequent watery stools. 

4. Excessive flow of saliva and perspiration. 

5. Rapid, then slow, shallow, difficult breathing. 

6. Slow, irregular, weak pulse. 

7. Contracted pupils. 

8. Twitchings of the muscles, beginning in the legs and 
extending to the upper extremities, with great musculai 
weakness. 

9. Collapse. 

Treatment 

1. Wash out the stomach. 

2. Keep the patient warm. 

3. Give artificial respiration. 

4. Atropine is given hypodermically. This is the antidote, 
as it paralyzes the overacting nerve endings, and increases 
the breathing. 

5. The collapse is usually treated with heart stimulants. 

Uses 
Eserine is principally used in the following conditions: 
1. To soften the eyeball in glaucoma, and to contract the 
pupil. 



408 MATERIA MEDICA 

2. To increase the peristalsis, to cause frequent move- 
ments of the bowels, and to expel gas. It is frequently 
used for the latter effect, on patients that have just been 
operated upon, and who have difficulty in passing gas; es- 
pecially after gynecological operations. It should be avoided 
when the operation has been performed upon the stomach 
or intestines. 

3. It is occasionally used in chronic constipation. 

Preparations 

Physostigma 
Extract of Physostigma 0.008-0.06 gm. gr. |-i 

(Extractum Physostigmatis) 

Tincture of Physostigma 1.0-3.0c.c. m. xv-xlv 

(Tinctixra Physostigmatis) 

Eserine 

Eserine Salicylate 0.001-0.003 gm. gr. ^V-A 

(Physostigminae Salicylas) 

Eserine Sulphate 0.001-0.003 gm. gr. ^V- A 

(Physostigminae Sulphas) 



CHAPTER XXIII 

DEPRESSANTS OF SECRETORY AND MOTOR NERVE ENDINGS 

SECRETORY DEPRESSANTS 

BELLADONNA GROUP 

The following group of drugs produce similar effects 
because they contain the same active principles. The ac- 
tive principles occurring in these plants are the following 
alkaloids : 

Atropine 

Hyoscyamine 

Hyoscine 

These alkaloids are closely related to one another, and 
some of them are compounds of still simpler alkaloids. Thus, 
atropine is a compound of two forms of hyoscyamine. 

By decomposing atropine and combining another acid 
with the compounds thus formed, artificial alkaloids are 
formed. Homatropine, for example, is formed when atro- 
pine is decomposed and then combined with another acid 
(oxytoluic acid). 

Hyoscine or scopolamine is also related chemically to 
atropine. 

The drugs which contain these alkaloids all belong to the 
group of plants known as the Solanaceae. (The potato and 
egg plants belong to the same group.) 

The following are the most important plants of the group : 

Atropa Belladonna (Deadly Nightshade) 

This contains atropine, with small quantities of hyoscya- 
jnine and hyoscine. 

Hyoscyamus Niger (Henbane) 

This usually contains hyoscyamine, hyoscine, and small 
quantities of atropine. 

409 



410 MATERIA MEDICA 

Datura Stramonium (Thornapple) 

This contains mostly atropine, hyoscyamine and small 
quantities of hyoscine. 

Duboisa Myoporoides 

Scopola Atropoides 

Mandragora Autumnalis or Atropa Mandragora (Mandrake) 

These are other less important drugs which contain atro- 
pine. 

BELLADONNA AND ATROPINE 

Belladonna is a drug obtained from the leaves and roots 
of the Atropa belladonna or Deadly nightshade. It is a peren- 
nial plant, about three feet high, which ordinarily grows in 
England and other parts of Europe, but it has also been 
cultivated in this country. 

Its active principles are the following alkaloids: 

Atropine 

Hyoscyamine 

Hyoscine 

The effects of belladonna are due principally to the 
atropine which it contains. This is preferred for internal 
use. 

Appearance of the Patient 

After administration of atropine, or one of the atropine 
containing drugs, such as belladonna or hyoscyamus, the 
following effects result within ten minutes to a half hour : 

The patient looks brighter, the face and neck are some- 
what flushed, and the pupils are dilated. He is more wakeful 
and brighter. 

The pulse is rapid and strong and the breathing is deeper 
and faster. Various cramp-like pains, such as pains in the 
stomach, intestines, or bladder, from which the patient may 
be suffering, are relieved. 

The patient is thirsty, complains of dryness of the mouth 
and throat. The skin usually feels dry, and may be quite 
red. 



SECRETORY AND MOTOR DEPRESSANTS 411 

If the patient has an attack of shortness of breath, this is 
usually relieved. 

ACTION 

Local action: On the skin, atropine relieves pain, and 
checks the secretion of sweat. This effect is produced by 
paralyzing the sensory nerve endings in the skin. It is 
often used for this purpose in the form of a belladonna 
plaster. Atropine or belladonna is readily absorbed from 
the skin if applied in a solution of alcohol, glycerine, oil, or 
camphor, or in the form of a plaster. It often causes general, 
even poisonous symptoms from such applications. On mu- 
cous membranes: It checks the secretion. 

Internal Action 

In the mouth; Atropine has a bitter, burning taste, and 
checks the secretion of saliva and mucus. It makes the 
mouth and throat feel dry. If this effect is marked, the 
patient is unable to swallow. 

In the stomach: It lessens the secretion of gastric juice and 
the peristalsis of the stomach. 

In the intestines : Atropme checks the secretion of the mu- 
cous membrane of the intestines and lessens the peristaltic 
contractions of its muscle wall. It is often used for this pur- 
pose to check the griping pains of cathartics. 

Action after Absorption 

Atropine enters the blood through the mucous membrane 
of the stomach and intestines. It is rapidly absorbed, usually 
within a half to one hour. It can also be absorbed from 
other mucous membranes. After absorption, it is carried 
by the circulation of the blood to various organs of the 
body; but it affects principally the heart, the respiration, 
the brain, all the secretory glands, the involuntary muscles 
and the pupils. 

Action on the heart: Atropine makes the heart beat faster 
and stronger. The systoles, or periods of contraction of the 
heart are increased, while the diastoles or periods of relaxa- 



412 MATERIA MEDICA 

tion are lessened. The heart then expels more blood; and 
with greater force. 

This effect is due to the paralysis of the nerve endings in 
the heart, of the Vagus or inhibitory nerves. The checking 
or slowing influence is then taken away from the heart, so 
that impulses for slowing the heart will not reach it. As a 
result, the accelerator nerves have full play, and the only im- 
pulses that reach the heart make it beat stronger and faster. 

Action on the blood vessels: The small arteries of the 

abdomen are constricted by the contractions of their muscle 
fibers, as a result of impulses v>^hich reach them from the 
vaso constrictor center in the medulla of the brain. The 
blood vessels of the skin, however, are widened. This causes 
the flushing of the face and neck, often noticed after ad- 
ministration of atropine. 

Atropine makes the pulse rapid strong, and tense. There 
may be a slight increase in blood pressure. 

Action on the respiration: Atropine makes the breathing 
faster and deeper by increasing the impulses for breathing 
that are constantly being sent from the respiratory center of 
the medulla. More air, and therefore more oxygen, is 
taken into the lungs. The blood is then able to take up 
more oxygen and to eliminate the carbon dioxide more 
rapidly. 

Action on the nervous system: Atropine increases the ac- 
tivity of the brain. This produces wakefulness and rest- 
lessness, because the patient is more conscious. This is due 
to the fact that the areas of the brain which receive sensa- 
tions are made more active. More sensations are then re- 
ceived through the various senses. The higher intellectual 
activities, such as reasoning and memory are not affected, 
however. 

The patient is more active and more talkative, because 
the motor and speech areas of the brain are more active, 
and these areas are constantly sending out more impulses. 

In overdoses, atropine causes symptoms of lessened 
brain activity (depression), because the brain then becomes 
exhausted from overactivity. 



SECRETORY AND MOTOR DEPRESSANTS 413 



Action on the secretory glands: Atropine lessens the se<^ 
cretion of all the secretory glands, as a result of lessening 
the action of the nerve endings of the secretory nerves in 
the various glands. 

Effect on Secretions 



Gland 



Digestive glands 



Secretion Effect 

Saliva Lessened ; excessive thirst 

Gastric juice Lessened 

Intestinal secretions Lessened 

Pancreatic juice Only water lessened. 
Secretion of its diges- 
tive ferments are not 
due to nervous influ- 
ences, biit to chemical, 
substances formed in 
the stomach (secretin) 

Bile Lessens change of gly-- 

cogen to sugar 
Lessened 
No effect 



Mucus 
Urine 



Mucous glands 
Kidneys 

Action on the involuntary muscles: Atropine lessens the 
contractions of all the involuntary muscles, by paralyzing 
the nerve endings of the nerves which carry impulses to these 
muscles. Thus, the peristalsis of the stomach and intestines, 
the contractions of the bladder, of the uterus, and of the 
bronchial muscles are all lessened by atropine. 

(Atropine, or drugs containing atropine, are often used to 
relieve contractions of the small muscle fibers of the bronchi 
which often produce asthmatic attacks.) 

Action on the pupil : Atropine dilates the pupil by paralyz- 
ing the nerve endings of the nerves in the circular muscle 
fibers of the iris, or colored part of the eye. The radial 
muscles then have free play, and their contractions widen 
the pupil. The pupil may remain dilated for days. 

Patients are often unable to see near objects clearly after 
atropine has been dropped into the eye. This is due to the 
paralysis of the nerve endings of the ciliary muscle, a muscle 
which changes the contour of the lens for near and distant 
objects (accommodation). The relaxation of this muscle 



414 MATERIA MEDICA 

prevents the lens from changing its contour for near objects, 
which cannot then be seen. 

Effect on the temperature: In large doses atropine often 
causes a rise of temperature. 

Excretion 

Atropine or a drug containing atropine, is excreted mainly 
by the kidneys. It is eliminated in about ten to twenty 
hours. Part of the drug is oxidized and used up in the body. 

Idiosyncrasies 

The following unusual effects occasionally occur: 

1. Ordinary doses of atropine sometimes cause delirium. 

2. When apphed to the conjunctiva of the eye, atropine 
often causes inflammation of the eyelids and face. 

3. The rash caused by atropine may spread all over the 
body, and the skin may peel (desquamate). It may be 
mistaken for scarlet fever. 

Poisonous Effects 

Acute atropine poisoning usually results from excessive 
doses of atropine or drugs containing atropine. Dangerous 
symptoms have resulted from gr. aV-rV ^^^ death has oc- 
curred in about six hours after it was taken. 

Since atropine is rapidly excreted, cumulative symptoms, 
or chronic atropine poisoning does not occur. 

Symptoms 

In giving atropine or atropine containing drugs the nurse 
should watch for excessive thirst and talkativenesSo She 
should report these symptoms to the physician as soon as 
they occur. 

The earliest and most characteristic symptoms of atropine 
poisoning are the following : 

1. Dryness of the mouth and throat. 

2. Excessive thirst. 

3. Difficulty in swallowing. 

4. Hoarseness. 



SECRETORY AND MOTOR DEPRESSANTS 415 

5. Flushed, dry skin, especially of the face and neck. 

6. Very rapid pulse and breathing. 

7. The pupils are widely dilated and near objects cannot 
be seen distinctly. 

// very large doses of atropine are taken, these symptoms 
are increased and may be followed by : 

1. Hoarseness, with difficult and indistinct speech, and 
talkativeness. 

2. Restlessness and wakeful delirium. 

The patient is very talkative, but his ideas are confused. 
He may begin a sentence and not finish it. He is very hght- 
headed, may burst into fits of laughter or tears. Occasionally 
there may be illusions or hallucinations of sight. Patients 
therefore often seem to see various objects about them. 

Soon a peculiar, wakeful, active, and talkative delirium 
develops. The patient lives in a world of his own; he talks 
to objects and persons which he seems to see about him. 
He is entirely oblivious to the real objects about him^ 
Often he is quarrelsome, even maniacal, and has to be re- 
strained. 

The excitement is usually followed by collapse: the skin 
becomes pale, cold and clammy, the pulse becomes rapid 
and w^eak, the breathing slow and shallow, and death may 
result. 

Frequently the excessive excitement is followed by stupor 
and coma, with slow and shallow breathing and cyanosis. 

Finally, tremors of the muscles and convulsions develop, 
the breathing becomes slow and shallow, the face becomes 
blue, and the patient dies from paralysis of respiration. 

Although atropine is a respiratory stimulant, the nurse 
should remember that from poisonous doses the respiratory 
center becomes depressed and may finally be entirely par- 
alyzed and death ensue. 

Treatment of Atropine Poisoning 

1. Wash out the stomach, or give emetics. 

2. Give tannic acid or old tea to combine with the atro- 
pine and neutralize it. 

3. Catheterize the patient, to avoid reabsorption of the 



416 MATERIA IMEDICA 

atropine from the urine in the bladder, especially since 
patients suffering from atropine poisoning do not pass 
much urine. 

5. Keep the body warm; give mustard baths. 

6. Give artificial respiration if the breathing is embar- 
rassed. 

7. Stimulants, such as caffeine, strychnine, are usually 
given. 

8. Do not give morphine; for, while atropine is the anti- 
dote for morphine, the dangerous effects of atropine are due 
to the exhaustion of the breathing. If morphine is given in 
such cases, the breathing is only made slower. Morphine, 
is not therefore an antidote for atropine, though atropine is 
an antidote for morphine. 

Uses 

The following are the most important uses of atropine or 
belladonna : 

1. In the form of a belladonna plaster or liniment, atro- 
pine or belladonna is used to reheve pain, on the site where 
it is applied. 

2. As a cardiac and respiratory stmiulant, especially 
where immediate effects are desired. 

3. As an antidote for morphine poisoning. It is very often 
given together with morphine to avoid poisonous effects. 

4. Atropine is often given to check secretions, for ex- 
ample, to check profuse sweating, or the secretion of milk. 

5. To lessen cramp-like pains produced by contractions 
of involuntary muscles. It is often prescribed together with 
purgatives to lessen their griping. It relieves the colic which is 
produced by the contractions of the involuntary muscles 
of the bile ducts resulting from the passage of a gall stone 
along these ducts. It also relieves the cohc of the ureters 
of the kidney (renal cohc) resulting from the passage of a 
stone or other substance along the ureter. 

By lessening the contractions of the involuntary muscles 
of the stomach, it often relieves the pains of an ulcer in the 
stomach. 

It frequently relieves painful urination produced by the 



SECRETORY AND MOTOR DEPRESSANTS 417 

spasmodic contractions of the involuntary muscles at the 
neck of the bladder. 

6. Atropine is very often used to relieve bronchial asthma. 
It is particularly valuable in this condition, because it 
lessens the spasms of the involuntary muscles of the bronchi, 
and at the same time it checks the secretion of its mucous 
membranes. 

7. Atropine is very often used to dilate the pupil, so that 
the retina or background of the eye may be more easily 
examined, and to prevent adhesions between the iris and 
lens, when the iris is inflamed. 

8. It is very often used in diabetes in large doses. It 
lessens the amount of sugar in the urine. The reason for 
this effect is unknown, but it may be due to lessened forma- 
tion of sugar from the liver cells. 

Preparations 
Preparations Made from the Leaves 
For Internal Use 
Extract of Belladonna Leaves 0.005-0.03 gm. gr. i\-| 
(Extractum Belladonnae Foliorum) 

Tincture of Belladonna Leaves 0.3 -1.0 c.c. m. v-xv 
(Tinctura Belladonnae Foliorum) 

For Local Use 
Belladonna Ointment 
(Unguentum Belladonnae) 

This contains about 10% of the extract of belladonna. 

Belladonna Plaster 
(Emplastrum Belladonnae) 

This contains 3 parts of the extract of belladonna and 7 
parts of adhesive plaster. 

Preparations Made from Belladonna Root 

For Internal Use 
Fluidextract of Belladonna Root 0.06-0.12 c.c. m, i-4i 
(Fluidextractum Belladonnae Radicis) 



418 MATERIA MEDICA 

For Local Use 
Belladonna Liniment 
(Linimentum Belladonnae) 

This consists of the fluid extract to which has been added 
about 5% of camphor. 

Preparations of Atropine 

For Internal Use 

Atropine 0.0004-0.001 gm. gr. jh - bV 

(Atropina) 

Atropine Sulphate^ 0.0004-0.001 gm. gr. ji-^ - ^\ 

(Atropinae Sulphas) 

For hypodermic use, atropine often com.es in tablets, 
each containing the required dose, or in i to 1% solutions. 

For Local Use 
Oleate of Atropine 
(Oleatum Atropinae) 

This contains about 2% of atropine. 

Atropine Ointment 
(Unguentum Atropinae) 
(Not official) 

This contains about 4% of atropine. 

Homatropine 

Homatropine is an artificial alkaloid of atropine. It is 
formed by a combination of tropine, an alkaloid obtained 
by decomposing atropine, with oxytoluic acid. 

The effects of homatropine are similar to those of 
atropine. It dilates the pupil more rapidly than atropine, 
and the effect is not as lasting. It is not so apt to cause 
general symptoms as easily as atropine from its local use; 
as in applications to the eye. 

Homatropine is used principally to dilate the pupil, by 
dropping a solution of the drug into the conjuctiva of the 
eve. 



SECRETORY AND MOTOR DEPRESSANTS 419 

Preparations 

de 0, 
(Homatropinae Hydrobromidum) 



Homatropine Hydrobromide 0.0006-0.001 gm. gr. yJo'^ 



This is used principally in i to 1% solutions for local ap- 
plications to the eye. 

STRAMONIUM (THORNAPPLE, JAMESTOWN WEED) 

Stramonium is obtained from the leaves of the Datura 
stramonium, a weed growing in England and the United 
States. It is known by various names, such as Jamestown 
weed, thornapple, or gypsum. Its active principles consist 
mostly of hyoscine but it also contains atropine and hy- 
oscyamine. 

Appearance of the Patient 

Stramonium is usually given to patients suffering from 
an attack of spasmodic asthma. 

When a preparation of stramonium is given, or the fumes 
of burnt stramonium leaves inhaled, the patient is relieved 
of the asthmatic attack. The breathing is easier, the pulse 
is strong and rapid. The patient complains of dryness of 
the mouth and throat and is very thirsty. The pupils are 
dilated, and the patient is somewhat more active and more 
talkative. 

Administration 

Stramonium is given in the form of cigarettes, which are 
smoked during an attack of asthma, or the leaves are burned 
in a saucer and the smoke inhaled. It relieves the attack 
by relaxing the spasmt of the involuntary muscles of the 
bronchi. 

Preparations 

Stramonium leaves made up into cigarettes, or the plain 
dried leaves are the most commonly used preparations. 

Extract of Stramonium 0.015-0.03 gm. gr. J-J 

(Extractum Stramonii) 

Fluidextract of Stramonium 0.06 -0.12 c.c. m. i-ii 
(Fluidextractum Stramonii) 



420 MATERIA MEDICA 

Tincture of Stramonium 0.3-1.0 c.c. m. v-xv 

(Tinctura Stramonii) 

Stramonium Ointment 
(Unguentum Stramonii) 

This contains 10% of the extract of stramonium. It is 
used principally for painful haemorrhoids. 

HYOSCYAMUS 

Hyoscyam^us is obtained from the leaves and flowering 
tops of Hyoscyamus niger or henbane, when the plant is two 
years old. It grows best in England, but it has been success- 
fully cultivated in the United States. It contains mostly 
hyoscyamine, also hyoscine and small quantities of atropine. 

Hj^oscyamine and hyoscine are chemically very much like 
atropine. 

The effects of hyoscyamus are quite similar to those of 
belladonna and atropine, except that they are much weaker. 

Preparations 

Extract of Hyoscyamus 0.03-0.2 gm. grs. ^-iii 

(Extractum Hyoscyami) 

Fluidextract of Hyoscyamus 0.2-0.6 c.c. m. iii-x 

(Fluidextractum Hyoscyami) 

Tincture of Hyoscyamus 1.0 -4.0 c.c. m. xv-5i 

(Tinctura Hyoscyami) 

HYOSCYAMINE 

Hyoscyamine is very rarely used. Its effects are the same 
as those of atropine, to which it is very closely related. It 
lessens the contractions of all the involuntary muscles more 
than atropine does. 

Preparations 

Hyoscyamine Sulphate 0.0005-0.001 gm. gr. i^^-^V 

(Hyoscyaminae Sulphas) 

Hyoscyamine Hydrobromide 0.0005-0.001 gm. gr. lio-A 
(Hyoscyaminae Hydrobromidum) 



SECRETORY AND MOTOR DEPRESSANTS 421 

HYOSCINE OR SCOPOLAMINE 

Appearance of the Patient 

About a half to one hour after the administration of 
hyoscine, the patient feels tired and drowsy. He becomes 
less active, less talkative and soon falls asleep. The sleep 
resembles the normal sleep, and lasts from about five to 
eight hours, though the patient may feel drowsy for some 
time after that. The pulse and breathing are slow, and the 
pupils are dilated. When the patient awakes, he usually 
complains of dryness of the throat and mouth, and is very 
thirsty. 

Hyoscine produces sleep more easily, if the room is dark- 
ened and loud noises avoided. 

ACTION 

The action of hyoscine resembles that of atropine with 
the following differences: 

1. Action on the pupil: It dilates the pupil more rapidly 
than atropine, but the effects last for only a short time. 

2. Action on the heart: It makes the heart beat slower. 
The pulse is therefore slower after hyoscine. 

3. Action on the respiration: Hyoscine does not increase 
the breathing as much as atropine does. 

4. Action on the brain: The activity of the brain is les- 
sened by hyoscine. It produces sleep, by lessening the 
action of the sensory areas of the brain. Fewer sensory im- 
pressions are then received, consciousness is therefore les- 
sened and sleep produced. It lessens especially the re- 
membrance of various sensations. A patient may not re<= 
member having seen certain objects or having had pain. 

The action of the motor and speech areas of the brain 
is also lessened. The patient is then less active, less talkative 
and feels tired. 

Occasionally, there is a short period of excitement before 
the patient falls asleep. He may feel dizzy and be quite 
active, though the movements are unsteady, and the speech 
becom.es difficult and indistinct. 



422^ MATERIA MEDICA 

Excretion 

Hyoscine is excreted mainly by the kidneys, more rapidly 
than atropine, usually in about eight to ten hours. 

Tolerance 

Patients may get accustomed to hyoscine, so that large 
doses may be given without producing any effects. 

Poisonous Effects 

The poisonous effects of hyoscine are similar to those of 
atropine. The patient has the characteristic symptoms of 
wild talkative delirium, dryness of the throat and mouth, dilated 
pupils, dry red skin, rapid pulse, and breathing, etc. 

Uses 

Hyoscine is usually given hypodermically, to produce 
sleep ; especially in cases of delirium, mania, delirium tremens, 
etc. It may cause collapse, however. 

SCOPOLAMINE MORPHINE ANAESTHESIA 
(Twilight Sleep) 

Hyoscine or scopolamine is given together with morphine 
to produce a state of mild unconsciousness or anaesthesia, so 
as to enable the performance of painless operations. It may 
be used alone or as a preliminary to a general anaesthetic. 

It has recently been used, however, for painless childbirth. 
The method, which is commonly known as 'Hwihght sleep'' 
consists in inducing the following effects : 

1. A drowsy state in which the consciousness, as well as 
the sense of pain is lessened. 

2. A loss of memory for pain. 

Method of Administration 

The desired condition is brought about by giving a dose of 
hyoscine with morphine as soon as labor pains start. The 
hyoscine alone is then repeated every hour; but each time in a 
smaller dose. 



SECRETORY AND MOTOR DEPRESSANTS 423 

The effect of the drug is enhanced by darkening the room 
and maintaining calm and quiet surroundings. 

To determine whether the desired effects are obtained, the 
nurse should test the patient's memory about every half 
hour, throughout the administration: by showing the pa- 
tient the same object at frequent intervals. When the 
patient does not remember the object seen, the desired 
effect is obtained. The same object should not be shown 
too often, however, as the test may then become unreliable. 
During treatment, the patient should be carefully watched, 
for symptoms of collapse and poisoning (atropine poisoning) . 
Many patients are delirious throughout the treatment, al- 
though they do not remember the pains. 

Preparations 

Hyoscine Hydrobromide 0.0003-0.0006 gm. gr. aio-xJo' 

(Hyoscinae Hyodrobromidum) 

Scopolamine Hydrobromide 
(Scopolaminae Hydrobromidum) 

This is the same as hyoscine hydrobromide. 

Euscopole (not official) 0.0003 gm. gr. 2^0 

This has a milder action than scopolamine. 

SCOPOLA 

Scopola is obtained from the underground stems of the 
Scopola atropoides, a plant which grows on the hills of 
central and southern Europe. It acts like atropine but has a 
soothing effect on the brain. 

Preparations 

Extract of Scopola 0.015-0.03 gm. gr. J-§ 

(Extractum Scopolae) 

Fluidextract of Scopola 0.06-0.12 c.c. m. i-ii 

(Fluidextractum Scopolae) 

Scopolamine hybrodromide is the same as hyoscine hydro- 
bromide and is given in doses of 0.0003-0.0006 gm. gr. aio^x^^ 



424 MATERIA MEDICA 



DUBOISIA 



Duboisia is obtained from the Duboisia myoporoides, an 
Australian shrub. Its actii^e principle is duboisine, an alka- 
loid which at one time consists of hyoscyamine and at other 
^ times of hyoscine. It is used to soothe nervous excitabil- 
it^^ Its action is like that of hyoscyamus. It is not often 
used. 

MANDRAGORA (MANDRAKE) 

Mandragora is obtained from the Atropa mandragora, or 
Mandragora autumnalis or mandrake. Its active principles 
are hyoscine, and other alkaloids. It resembles hyoscyamus 
in its action. It is rarely used. 

PAPAVERINE 

Papaverine is one of the alkaloids obtained from opium. 
Papaverine acts like morphine only to a very slight degree. 
It relieves pain and lessens the activity of the brain only 
slightly but it is somewhat of a local anaesthetic. 

Recently however, it has been found to have a marked 
effect upon the involuntary muscles. It lessens the contrac- 
tions of all involuntary muscles such as those of the stomach, 
the ureters, gall ducts, and intestines. 

It is therefore used to lessen the pains caused by the spasm 
of the involuntary muscles in ulcer of the stomach, gall stone 
colic, kidney colic, painful menstruation and painful urina- 
tion. It is also used to lower blood pressure and to lessen 
the convulsions in eclampsia. 

Papaverine does not induce a habit. 

Preparations 

Papaverine 0.03-0.08 gm. gr. |-1| 

Papaverinae 

Papaverine Hydrochloride 0.03-0.08 gm. gr. ^-i| 

Papaverinae hydrochloridum 

This also comes in tablets each containing 0.04 gm. 

Papaverine sulphate 0.03-0.08 gm. gr.|-i|^ 

Papaverinae sulphas 



SECRETORY AND MOTOR DEPRESSANTS 425 

BENZYL BENZOATE 

Benzyl benzoate is a colorless oily liquid formed by the 
combination of benzyl alcohol with benzoic acid. (Such a 
compound, formed by the combination of an alcohol with 
an organic acid is called an ester.) Benzyl benzoate may 
be obtained by the distillation of balsam of Peru or the bal- 
sam of Tolu. It is also present in various other balsams and 
in the volatile oils of various flowers such as gardenias, jas- 
mine, tuberose, hyacinth and orange blossoms. 

ACTION 

Benzyl benzoate, like papaverine acts principally on the 
involuntary muscles, but it is much more efficient. It re- 
lieves the spasm of all involuntary muscles such as. those of 
the intestines, the gall bladder, the ureters, the bronchi and 
the blood vessels. 

It is used principally to check the pains due to spasm 
in gall stone colic, kidney colic and abdominal cramps. It 
is also used to check diarrhoea in chronic dysentery and 
mucous colitis and to lower blood pressure. 

Administration 

Benzyl benzoate has a very unpleasant taste. It should 
therefore be given in a thick syrup. It is usually prescribed 
in the form of a thick mixture with mucilage of acacia and 
flavored with a sjTup or an elixir such as the elixir of lacto- 
peptone or the Elixir of Eriodyctyon. 

Preparations 

Benzyl benzoate 0.6-2-0 c.c. m. x-xxx 

Benzyl benzoas 

This is a liquid which is a 20% alcoholic solution. 

OTHER SECRETORY DEPRESSANTS 

AGARICUS AND AGARICIN 

Agaricus is a fungus, the white agaric, or Agaricus albus 
or Boletus lands, which grows on the European larch tree. 
Its active principle is an acid, agaric acid, or agaricin, 
which is the preparation principally used. 



426 MATERIA MEDICA 

ACTION 

Agaricin checks the secretion of sweat, by paralyzing the 
nerve endings in the sweat glands which cause secretion. 
The effect, however, is not as marked as that of atropine. 
Secretions of the other secretory glands are not affected by 
agaracin. It often causes nausea and frequent movements 
of the bowels. It does not affect the heart, respiration or 
pupils. It is used principally to check the night sweats of 
tuberculosis. It should be given about 4 or 5 hours before 
the expected sweat. 

Preparations 
Agaricin 0.005-0.06 gm. gr. T2~i 

This is best given in pill form about five or six hours be- 
fore retiring, as it is very slowly absorbed. 
Agaric Acid (not official) 0.015-0.03 gm. grs. J-| 

(Acidum Agaricum) 

This is a very poisonous substance. Overdoses cause 
vomiting, diarrhoea and collapse. 

CAMPHORIC ACID 

Camphoric acid is a small white crystalline powder, 
formed by the action of nitric acid on camphor. It is used 
to check sweating. 

Camphoric Acid 1.0-2.0 gms. grs. xv-xxx 

(Acidum Camphoricum) 
THALLEIN ACETATE 0.06-0.2 gm. grs. i-iii 

This is a white crystalline powder used to check night 
sweats. Its continued use is said to cause baldness. 

MOTOR DEPRESSANTS 

GELSEMIUM 

Gelsemium is obtained from the roots and underground 
stems of the Gelsemium sempervirens, yellow jasmine, or 
Carolina jasmine, a climbing plant of the southern United 
States. Its active principles are two alkaloids: gelsemine 
and gelseminine, the gelsemine being the more active of the 
two. 



SECRETORY AND MOTOR DEPRESSANTS 427 

Appearance of the Patient 

About fifteen minutes to a half hour after giving a dose 
of gelsemium, the patient feels tired and languid. The pulse 
is perhaps somewhat slower and weaker. If the patient has 
had muscular twitchings, these are lessened. 

ACTION 

The only local effect produced by gelsemium is the dilata- 
tion of the pupil, which follows its application to the con- 
junctiva. 

Internal Action 

When taken internally, gelsemium is readily absorbed 
into the blood in about fifteen- to twenty minutes, and it 
then affects principally the muscles, the respiration and 
slightly the heart. 

Action on the muscles: Gelsemium lessens the contractions 
of the muscles by paralyzing their nerve endings, which re- 
ceive the impulses for their contractions. In this way it 
lessens muscular twitchings, which are very fine muscular 
contractions. 

Action on the respiration: Large doses of gelsemium make 
the breathing slow and shallow. 

Action on the circulation: The pulse is made slow^er and 
weaker by large doses. 

Excretion 

Gelsemium is rapidly eliminated from the body by the 
urine, usually in about two to three hours. 

Poisonous Effects 

An overdose of gelsemium usually causes the following 
serious symptoms; which may often endanger the patient's 
life. 

Symptoms 

1. The patient becomes tired, languid and drowsy, but 
does not fall asleep. 

2. The movements of the muscles become weak and un- 
steady, the jaw drops, the eyes may be tired, or the eyelids 



428 MATERIA MEDICA 

may droop, and the pupils dilate. The speech is often 
indistinct, and the patient staggers as soon as he attempts 
to walk. (These symptoms are due to the beginning paraly- 
sis of the muscles.) 

3. Occasionally there is nausea and vomiting with profuse 
flow of saliva. 

4. The skin is moist, cold and insensitive to pain. 

5. The pulse is slow and weak. 

6. The breathing becomes very slow and shallow, and 
death results from the paralysis of the breathing. 

The patient is conscious to the last, though there may 
be partial blindness before death. 

Treatment 

1. Wash out the stomach. 

2. Keep the patient quiet. 

3. Give artificial respiration. 

4. Heart stimulants such as atropine, strychnine, etc., are 
usually given. 

Uses 

Gelsemium is used principally to relieve the very painful 
spasms of the muscles of the face in 'Hie douleureux" of 
trigeminal neuralgia. 

Preparations 

Fluidextract of Gelsemium 0.03-0.12 c.c. m. |-ii 

(Fluidextractum Gelsemii) 

Tincture of Gelsemium 0.06-0.3 c.c. m. i-v 

(Tinctura Gelsemii) 

CONIUM (SPOTTED HEMLOCK) 

Conium is obtained from the fruit and flowers of the 
Conium maculatum, or poison hemlock, a European plant. 
Its active principle is coniine, a volatile fluid alkaloid. 

ACTION 

Applied locally, conium causes iutense redness and sweUing. 
When taken internally, it acts like gelsemium, causing 
muscular weakness by paralyzing the nerve of the muscles. 
In large doses it makes the breathing slower. 



SECRETORY AND MOTOR DEPRESSANTS 429 

Poisonous Effects 

Conium poisoning has become famous because it was the 
means with which Socrates, the famous Greek philosopher, 
was killed. This was the method then used in Athens to 
kill criminals. 

Symptoms 

1. The lower extremities become weak and heavy. The 
patient lies down because of the weakness. If he attempts 
to walk, he staggers and falls. The eyes may be turned in, 
the lids may droop, and the pupils are dilated. The patient 
complains of headache and he can hardly lift his head. 

2. The pulse is slow at first, but soon becomes rapid and 
weak. 

3. The skin is moist and cold. 

4. The breathing becomes slow and shallow, and the 
patient dies in a short time from arrest of breathing. 

Uses 

Conium is very rarely used at present, possibly once in a 
great while to lessen the spasms of whooping cough. It is 
a very dangerous drug. 

Preparations 
Fluidextract of Conium 0.1-0.5 c.c. m. ii-viii 

(Fluidextractum Conii) 

SPARTEINE 

Sparteine is a fluid alkaloid which is contained in scoparius 
or broom tops. 

ACTION 

When given internally, its effects appear in half an hour 
and last for several hours. It is absorbed from the stomach, 
and it then acts like gelsemium or conium. It weakens 
muscular contractions by paralyzing the nerve endings in 
the muscles. It is not as poisonous as either of these drugs, 
but it affects the heart more. 

Action on the heart; Sparteine makes the heart beat slower 
and weaker; by weakening the contractions of the heart 
muscle, thereby causing a slow, weak pulse. 



430 MATERIA MEDICA 

Sparteine was formerly considered a heart stimulant, 
but its use for this purpose has been given up, as its action 
seems to contraindicate such use. 

Sparteine does not increase the flow of urine as does 
scoparius, the crude drug from which it is obtained. 

Poisonous Effects 

The poisonous effects of sparteine are the same as those 
of conium. 

Preparations 

Sparteine Sulphate 0.004-0.1 gm. gr. yWii 

(Sparteinae Sulphas) 

LOBELIA (INDLAN TOBACCO) 

Lobelia is obtained from the leaves and tops of the Lobelia 
inflata or Indian tobacco, an American plant. Its active 
principle is an alkaloid lobeline. 

ACTION 

When taken internally, lobelia produces the following 
effects: 

1. It increases the secretions of the stomach and intes- 
tines, often causing nausea and vomiting, and occasionally 
frequent movem_ent of the bowels. 

2. It lessens the contractions of the involuntary muscles of the 
bronchi. 

3. It increases the secretions; such as the saliva, the mucus 
from the bronchi, etc. 

4. The pulse is usually slower, but soon becomes rapid and 
weak. 

5. The breathing is somewhat slower. 

Poisonous Effects 

xAn overdose of lobelia usually causes the following 
s^miptoms : 

1. Nausea, and profuse vomiting. 

2. Occasionally frequent movements of the bowels, 

3. Great weakness and relaxation of the muscles. 



SECRETORY AND MOTOR DEPRESSANTS 431 

■ 4. Collapse (rapid thready pulse, slow shallow breathing, 
cold moist skin, and dilated pupils) . 

5. Convulsions, stupor, coma and death from paralysis 
of the breathing. 

Uses 

- Lobelia is occasionally used to lessen the contractions of 
the involuntary muscles of the bronchi, in asthma; but be- 
cause of its dangerous poisonous effects, its use has mostly 
been given up. It is occasionally used in the form of an 
infusion, to relieve poison ivy rash. 

Preparations 

Fluidextract of Lobelia 0.06-0.3 c.c. m. i-v 

(Fluidextractum Lobeliae) 

Tincture of Lobelia 0.6-4.0 c.c. m. x-3 i 

(Tincture Lobeliae) 

TABACUM (TOBACCO) (not official) 

Tobacco is the dried leaves of Nicotiana tabacum, a plant 
growing in tropical countries. It contains nicotine, a very 
poisonous volatile fluid alkaloid. It also contains pyridine, 
a substance which acts like nicotine, tobacco camphor and 
an oil. 

Tobacco is not used as a medicine, but it is habitually 
used as a luxury by many individuals. It is smoked in the 
form of cigarettes or cigars, it may be chewed or taken as 
snuff. 

ACTION 

Tobacco, because of its nicotine acts like lobeha. It lessens 
the contractions of all the involuntary muscles. A strong 
cigar will often relieve an attack of asthma, by lessening the 
contractions of the involuntary^ muscles of the bronchi. 

It increases the peristalsis and often acts as an excellent 
cathartic. It increases the flow of urine. 

In persons who do not smoke habitually, tobacco often 
causes nausea, vomiting, headache, dizziness and weakness. 
In those who smoke habitually, it does not produce such 
effects. 



432 MATERIA MEDICA 

Poisonous Effects 

Nicotine is one of the most violent poisons known. It 
causes symptoms like those of lobelia poisoning, which come 
on very rapidly and cause death. 

Chronic tobacco poisoning is a frequent condition which 
follows excessive smoking. The symptoms are due to the 
nicotine which the tobacco contains. The patient usually 
complains of palpitation of the heart, he has a rapid irregular 
pulse and is very nervous. 

CURARA (not official) 

Curara, woorara, woorali or urari, is an arrow poison which 
is used by the South American Indians. It is made from 
the bark of various trees, such as the Strychnos toxifera. 
Its active principle is an alkaloid, curarine. It is rarely 
used in practical medicine, but it is frequently used in 
animal experiments. 

Curara paralyzes the nerve endings of all the muscles, 
thereby lessening their contractions. It causes a rapid weak 
pulse, by making the heart beat faster as a result of the 
paralyzed nerve endings of the Vagus nerve in the heart, 
which curara causes. The blood pressure is lowered, how- 
ever. 

It increases peristalsis and all the secretions. Curara is 
occasionally used to lessen the spasms of tetanus, hydro- 
phobia, etc., but its use is dangerous on account of its weak- 
ening action on the heart. It is given in doses of gr. J; or 
curarine, the alkaloid is given in doses of gr. 2io-T¥o' 



CHAPTER XXIV 

LOCAL ANAESTHETICS 

(Depressants of the Sensory Nerve Endings) 

The following drugs are used to produce insensibility to 
pain, or anaesthesia, only on the tissues over which they 
are applied. Drugs which produce such an effect, are called 
local anaesthetics. 

Many of the local anaesthetics are applied directly to the 
surface of the skin or mucous membranes, while others are 
injected underneath the skin (hypodermically). 

COCAINE 

Coca is obtained from the dried leaves of the Erythroxyion 
coca, a shrub growing in Peru, Bolivia and other South 
American countries. It is now also cultivated in India, 
Java and Ceylon. 

The coca leaves are extensively used by the natives of 
South America. They chew it when they have hard work 
to do, so as not to tire easily, and to lessen hunger. 

Cocaine is an alkaloid, the active principle of coca leaves. 
In the Java coca, in addition to the cocaine, another alkaloid 
is present: tropacocaine. Cocaine is easily decomposed and 
various artificial combinations are made from it; such as 
cocamine, isococamine, etc. 

The effects of the coca leaves are due principally to the 
cocaine which it contains. In practical medicine, cocaine 
preparations are principally used. 

Appearance of the Patient 

A hypodermic injection of an average dose of cocaine, or its 
application to the mucous membranes, usually produces in- 
sensibility to pain on the area where it is injected or on the 
mucous membrane on which it is applied. As soon as the 

433 



434 MATERIA MEDICA 

cocaine is absorbed, usually in ten or fifteen minutes, if the 
dose has been large, the patient becomes restless, some- 
what more active, and more talkative. He usually feels 
happy and jo^^ul. The patient often complains of headache, 
drjoiess of the throat; the pulse is rapid, strong and small, 
the breathing is rapid and deep, and the pupils are dilated. 

ACTION 

Local action: Applied to the skin, cocaine produces no 
effects, but if it is injected under the skin, or apphed to a 
wounded surface, it reheves pain. If it is injected into a 
nerve, it lessens pain in the area of skin or mucous mem- 
brane from which the nerve fibers come. 

On mucous membranes: Cocaine reheves pain and makes 
the membrane very pale and thin, by contracting its blood 
vessels. It also checks bleeding by contracting the blood 
vessels. 

The insensibihty to pain, or anaesthesia, produced by 
cocaine, lasts only for a short time: for about fifteen 
minutes to a hah hour, depending on the strength of the 
solution used. As soon as the cocaine is absorbed, the an- 
aesthesia and pallor disappear. Cocaine produces insensi- 
bility to pain by paralyzing the nerve endings, in the skin or 
mucous membranes, which receive impressions oi pain. 

The mucous membrane of the eye, nose, phar^mx, larynx, 
oesophagus, stomach, urethra, bladder, vagina and rec- 
tum, are all affected in this way, if cocaine is apphed di- 
rectly to these mucous membranes, and it is absorbed from 
all of them. In the nose, in addition to the effects on 
the mucous membrane, it lessens the sense of smell, by 
paralyzing the nerve endings which receive impressions of 
smeU. 

Internal Action 

r 

In the mouth: Cocaine has a bitter taste for a short time, 
as it soon paralyzes the nerve endings in the tongue which 
appreciate bitter substances. It also lessens pain on the 
mucous membrane of the mouth, and contracts its blood 
vessels. 



LOCAL ANAESTHETICS 435 

In the stomach : Cocaine acts as a local anaesthetic, and it 
contracts the blood vessels "^of the mucous membrane. It 
often lessens vomiting and hiccough, by paralyzing the nerve 
endings in the stomach, so that impulses which cause vomit- 
ing or hiccough are unable to reach the brain. 

Action on the intestines: Since cocaine is so rapidly ab- 
sorbed from the stomach, it affects the intestines only after 
absorption. It increases the peristalsis, causing more fre- 
quent movements of the bowels. 

Action after Absorption 

Cocaine is very rapidly absorbed into the blood from all 
mucous membranes, and from any region of the body where 
it may be injected; usually in about ten or fifteen minutes. 
After absorption it affects principally the circulation, the 
respiration, the brain, the pupil, the kidney, and slightly 
the muscles. 

Action on the circulation : On the heart : Cocaine makes the 
heart beat stronger and faster. It increases the contractions 
of the heart muscle, and it also causes the cardio accelerator 
center in the medulla of the brain, to send more impulses to 
the heart to make it beat faster. 

On the blood vessels : Cocaine makes the blood vessels nar- 
rower, by contracting the small muscle fibers in their walls, 
and increasing the impulses for their contraction, which are 
sent out from the vaso motor center in the medulla of the 
brain. 

The total effect of cocaine on the circulation, is to make 
the heart beat stronger and faster, and to increase the 
blood pressure. The pulse is therefore rapid, strong, but 
small. 

Action on the respiration: Cocaine makes the breathing 
faster and deeper. 

Action on the brain : In large doses it increases the activity 
of every part of the brain. The patient is wakeful, and more 
susceptible to receive impressions from his surroundings, as a 
result of the increased activity of the sensory areas of the 
brain. He is usually more active, walks about and becomes 



436 MATERIA MEDICA 

more talkative. These effects are due to the increased 
activity of the motor and speech areas of the brain. 

The mental activities of the brain are also increased, so 
that all kinds of mental work such as reasoning, memory, 
etc., are performed better. 

The emotions, especially the pleasant ones, are more 
active and the patient is somewhat joyful and happy. 

Overdoses cause at first, greatly increased activity of the 
brain, and then, from exhaustion, very much lessened ac- 
tivity (see poisonous effects) . 

Action on the muscles: In large doses cocaine slightly 
increases the contractions of all the muscles. 

Action on the pupils: It rapidly dilates the pupil, usually 
in about a half to one hour. It does not affect the sight for 
near and distant objects (accommodation). The effect 
wears off in about twenty-four hours. 

Action on the kidney: Cocaine increases the secretion of 
urine, as a result of its effect on the circulation and the 
blood vessels of the kidneys. 

Excretion 

Cocaine is partly excreted by the urine, but most of it is de- 
stroyed in the body. 

Poisonous Effects 

Cocaine poisoning occurs in two forms: acute cocaine 
poisoning, and cocaine habit, or chronic cocaine poisoning. 

Acute Cocaine Poisoning 

Acute cocaine poisoning results from overdoses of cocaine 
injected hypodermically, or from its application to the mu- 
cous membranes for local anaesthesia. The symptoms are 
due to overactivity of the various organs of the body which 
cocaine principally affects, followed by exhaustion of these 
organs, which then produce symptoms of lessened activity 
or depression. The symptoms vary somewhat in different 
individuals. Some individuals are so susceptible to the 
drug that small doses may cause poisonous effects. 



LOCAL ANAESTHETICS 437 

Symptoms 

L Usually the patient becomes quite talkative, happy and 
jolly, though he may be somewhat confused in his speech 
and ideas. He is quite anxious about his condition. 

2. He is quite active and moves about a great deal. 

3. The puis* is very rapid and small, and the breathing is 
very rapid. 

4. The skin is pale, and covered with sweat. 

5. The pupils are widely dilated. 

6. Occasionally there may be vomiting. 

7. Soon the delirium becomes more marked, the patient 
may seem to see objects about him^ he may have muscular 
contractions of the hands and feet. These are soon followed 
by either clonic or tonic convulsions, more often clonic. 

8. Finally the convulsions increase, coma and collapse 
develop and death ensues. 

9. At times there may be no convulsions and no excite- 
ment, but sudden collapse and death. Occasionally the 
patient may be maniacal. 

Treatment 

1. Reassure the patient that his condition is not serious. 

2. Apply an icebag to the head. 

3. The collapse is treated with stimulants. 

COCAINE HABIT 

The cocaine habit is unfortunately very common, and is 
often induced by its beneficial effects in the nose for the relief 
of hay fever, catarrh, etc., as well as from its use as a sub- 
stitute for morphine. It is usually taken in a liquid or pow- 
der form. The powder is usually snuffed up into the nose. 
Many of the cocaine habitues are also addicted to the use 
of other habit-forming drugs, such as morphine, etc. 

Besides the gradual disturbance in the general health, the 
cocaine habitue develops symptoms : 

1. When not under the influence of the drug. 

2. After he has received his usual dose. 

When not under the effects of the drug, the individual feels 



438 MATERIA MEDICA 

depressed and is usually nervous, irritable and has twitching 
of the hands and arms. He is restless and cannot con- 
centrate his mind on anything, and is unable to do his 
work. 

When he has received his usual dose, the habitue usually 
brightens up, feels stronger and more energetic and his 
former symptoms disappear. 

After continued use, however, he passes into a weakened 
condition of both body and mind. He becomes thin, ema- 
ciated and anaemic. He suffers from various digestive 
disturbances, a loss of appetite, a foul breath, a drooHng of 
saliva from the mouth, and constipation. He is usually 
unable to sleep. Frequently, habitues develop ascites (fluid 
in the abdomen). 

Finally, however, his mental and moral faculties become 
undermined and he eventually becomes a burden to himself, 
his family and friends; and an economic loss to society. He 
has no will power, no self control, and does not want to 
work. He is careless of his person and of his actions. He 
forgets his responsibihties, neglects his family and develops 
all sorts of base moral tendencies. He usually has various 
nervous symptoms; such as twitching of the muscles and 
peculiar sensations on the skin. Many votaries frequently 
develop hallucinations and a peculiar jumping delirium, and 
others become insane. 

The condition is best treated in special sanitariums; and 
the method consists of gradually withdrawing the drug. 



Uses 

Cocaine is the best drug for local anaesthesia. It is readily 
absorbed into the blood, however, and may then cause poi- 
sonous symptoms. To avoid these symptoms, it should be re- 
membered that the total amount of any solution of cocaine 
to be injected should not contain more than 0.03 gm. (gr. |) 
of cocaine hydrochloride, which is its maximum dose. 

As a local anaesthetic, cocaine is given in the following 
ways: 

1. On mucous membranes, such as the nose, throat or 



LOCAL ANAESTHETICS 439 

larynx, it is applied with a cotton applicator. A 10 or 20% 
solution is used for this purpose. 

Occasionally a few drops of a solution of cocaine crystals 
dissolved in epinephrine or adrenalin, are used. Such a 
solution contracts the blood vessels very markedly, pre- 
vents the absorption of the cocaine and at the same time 
produces a maximum anaesthetic effect. 

2. Infiltration anaesthesia. This is a method of inject- 
ing cocaine in very weak solutions, such as a 1-1000 to J% 
solution. For large areas, large quantities of weaker solu- 
tions may be used. For small areas, stronger solutions such 
as 4% may be used. To avoid poisonous effects, the cocaine 
is often injected together with epinephrine or adrenalin 
solutions. There are a number of preparations made up 
in this way. The following are the most common prepara- 
tions of this kind: 

Braun's Solution 

This consists of 

Cocaine hydrochloride 0.5-0.1 

Sodium chloride 10.0-100.0 

Adrenalin chloride solution 0.3-0.6 

Schleich's Solution 
This is made by dissolving 3 tablets, each of which con- 
tains 

Cocaine hydrochloride 0.03 gm. 

Morphine hydrochloride 0.008 gm. 

Sodium chloride 0.06 gm. 

in 100 c.c. of water. 

The absorption of cocaine is often prevented by tying a tight 
bandage around the part to be anaesthetized, so as to con- 
tract its blood vessels.. 

3. Cocaine is also occasionally injected into the nerve 
leading from the part to be operated upon. This lessens 
the sensibility of the area from which the nerve fibers come. 

Cocaine is also used to relieve colds in the nose (acute 
coryza), and to check vomiting and hiccough. 



440 MATERIA MEDICA 





Preparations 


' 




Coca 




Wine of Coca 


4.0-16.0 c.c. 


5i-3| 


(Vinum Cocae) 


Cocaine 




Cocaine 


0.008-0.03 gm. 


gr. ^-1 


(Cocaina) 







This is seldom used because it does not dissolve readily 
in water. It does dissolve in oils. 

Cocaine Hydrochloride 0.008-0.03 gm. gr. |-| 

(Cocainae Hydrochloridum) 

For local applications, watery solutions are used in 
strengths varying from ^% to 10%. For nose and throat 
work 20% solutions are often used, or even the powdered 
' cocaine dissolved in adrenalin solution may be used. 

Eupthalmine (not official) 

This is an artificial alkaloid which is used in 2% solutions 
to dilate the pupils. It does not affect the circulation. 

EUCAINE 

Eucaine is an artificial alkaloid which is used as a local 
anaesthetic. It produces local anaesthesia, like cocaine. 
It differs from cocaine, however, in the following ways : 

1. It does not contract the blood vessels. 

2. It slows and weakens the contractions of the heart, by 
directly affecting the heart muscle, thereby causing a slow, 
weak pulse, with low blood pressure. 

3. It does not dilate the pupil. 

Administration 

For local anaesthesia in the eye, it is used in a |% solu- 
tion. On other mucous membranes, it is applied in 2-10% 
solutions. 



LOCAL ANAESTHETICS 441 

For infiltration anaesthesia, it is used in a 1-500 to 1% 
solution. 

Eucaine is not as poisonous as cocaine, and can be boiled. 

It is also often used in the form of an ointment for painful 
haemorrhoids. 

Preparations 

Eucaine is called beta eucaine, to distinguish it from alpha 
eucaine which was formerly used as a local anaesthetic, but 
because of dangerous symptoms which it produces, has now 
been given up. 

Beta Eucaine Hydrochloride 
(Beta Eucainae Hydrochloridum) 

Beta Eucaine Lactate 
(Beta Eucainae Lactas) 

This is more soluble than the hydrochloride salt. 



TROPACOCAINE 

Tropacocaine is an alkaloid obtained from the leaves of 
the coca plant of Java. It is usually made artificially, how- 
ever. 

ACTION 

Tropacocaine is used principally to produce local anaes- 
thesia. Its effects are similar to those of cocaine, but they 
appear sooner, and last longer than those of cocaine. It does 
not dilate the pupil as much as cocaine. 



Preparations 

Tropacocaine Hydrochloride 0-03-0.06 gm. gr. |-i 

(Tropacocainae Hydrochloridum) 

This is used principally in 3-10% solutions. 



442 MATERIA MEDICA 

HOLOCAIN 

Holocain is an artificial alkaloid made from phenacetine. 
Its effects are similar to those of cocaine, but they appear 
sooner. It is also an antiseptic. It occasionally causes poi- 
sonous symptoms. 

Preparations 

Holocain Hydrochloride 
(Holocainae Hydrochloridum) 

It is principally used in a 1% solution as a local anaes- 
thetic in the eye. 

NOVOCAINE or PROCAINE 

Novocaine or Procaine is an artificial alkaloid which is used 
as a local anaesthetic. It acts like cocaine, but it is less 
poisonous and its effects wear off quickly. It is usually given 
together wdth epinephrine. It is not of much value when ap- 
plied on mucus membranes. The effects are only produced 
when it is injected hypodermically, but they are not lasting. 
The dissolved tablet is injected in 50 or 100 c.c. of normal salt 
solution. It is usually given with 0.3-0.6 c.c. of epinephrine. 

Preparations 

Novocaine or Procaine Tablets Each tablets contains 

0.02-0.2 gm. gr. i-iii 

There are also tablets containing novocaine and adrenalin. 

Novocaine Nitrate or Procaine Nitrate 0.02-0.2 gm. gr. |-iii 
(Novocainae Nitras) 

It is usually used in a 3% solution. 

ALYPIN 

Alypin is an artificial alkaloid which is used as a local 
anaesthetic. It is supposed not to produce poisonous symp- 
toms. 

It is used principally a,s a local anaesthetic for eye opera- 



LOCAL ANAESTHETICS 443 

tions, and in the urethra and bladder, before passing instru- 
ments into these organs. 

In the eye it is used in 1-2% solutions. On other mucous 
membranes, it is used in 1-10% solutions. 

Preparations 
Alypin Tablets Each tablet contains 0.02-0.2 gm. grs. ^-iii 

STOVAINE 

Stovaine is an artificial alkaloid which is used principally 
as a local anaesthetic and for spinal anaesthesia. Its effects 
are similar to those of cocaine with the following differences : 

1. It dilates the blood vessels. 

2. It is less poisonous than cocaine. 

In the eye it is used in a 4% solution. On other mucous 
membranes, in a 5-10% solution. Hypodermically, it is 
used in a i-1% solution. 

Preparations 
Stovaine (in tablets) each containing 0.002 gm. gr. ~. 

ORTHOFORM 

Orthoform is an artificial chemical substance formed by 
the combination of methyl alcohol and amidoxybenzoic acid 
(such a combination of an alcohol and an acid is called an 
ester) . 

It is used as a local anaesthetic like cocaine, but since it is 
very slowly absorbed, it produces no general effects and no 
poisonous symptoms. It is not used hypodermically. It 
is used principally to relieve pain on a wounded surface and 
on mucous membranes. It is often used to relieve the pain 
of an ulcer in the stomach. 

Preparations 

Orthoform New 0.5-1.0 gm. grs. viii-xv 

It is often applied on wounds in the form of a dusting 
powder or as an ointment. 



444 MATERIA MEDICA 

ANAESTHESIN 

Anaesthesin is a chemical substance used as a local anaes- 
thetic. It is an ester of alcohol and paramidobenzoic acid. 

ACTION 

The effects of anaesthesin are similar to those of cocaine. 
It produces local anaesthesia, but no general effects, as it 
does not dissolve readily and is not absorbed. 

It is used internally to relieve the pain of ulcers in the 
stomach or of cancer of the stomach. It is also applied to 
relieve pain on the mucous membrane of the nose, throat, 
urethra, etc., and on wounded surfaces. 

Preparations 
Anaesthesin 0.3-0.5 gm. grs. v-viii 

It is also used in the form of a powder or an ointment. 

Cycloform 0.1-0.2 gm. grs. i-iii 

It produces the same effects as anaesthesin, but is some- 
what antiseptic. 

Propaesin 0.25-0.5 gm. grs. iv-viii 

This acts like anaesthesin and it also contracts the mucous 
membrane. It is often used in 1-20% ointments. 

MAGNESIUM SULPHATE 

Magnesium sulphate or Epsom salt is used principally as 
a purgative. Applied locally however, it has a slight anaes- 
thetic effect. When injected into the spinal canal it pro- 
duces anaesthesia. The patient loses consciousness and the 
muscles become relaxed. Magnesium sulphate paralyzes the 
sensory nerve endings and the nerve terminals in the muscles. 
As a result sensations are no longer felt and the muscles are 
relaxed. When it is given hypodermically or intravenously 
the same effects are produced but the anaesthesia is not so 
evident. 



LOCAL ANAESTHETICS 445 

Uses 

Magnesium sulphate is applied locally in saturated solu- 
tions to inflammations of the skin and other skin diseases. 
It is also applied locally in the same solutions for rheumatic 
swellings of the joints, neuritis, etc. It relieves the pain by 
its local anaesthetic effect and the swelling by the fact that 
the saturated solution withdraws fluid from the tissues. 

Internally it is given as a sahne purgative. It is injected 
hypodermically in 1.0 c.c. doses of a 25% solution in 
tetanus, strychnine poisoning and eclampsia to lessen the 
convulsions. In severe cases it is given intravenously for 
the same purpose. 

When it is given as an anaesthetic it is injected into the 
spinal canal. The patient lies on the back and about 5 to 
10 c.c. of a 6% solution is injected into the spinal canal 
every few minutes until anaesthesia is produced. The 
method is not devoid of danger as respiratory difficulty 
may occur. When poisonous symptoms occur, they are 
treated by intravenous injections of small amounts of a 
2.5% solution of calcium chloride, by artificial respiration, 
by intermittent inflation of the lungs through a tube into 
the trachea, and by giving eserine as an antidote. At the 
same time the spinal canal is washed out with normal salt 
solution or with Ringer's solution. 

SPINAL ANAESTHESIA 

Anaesthesia is often produced by injecting a solution of 
one of the local anaesthetics into the spinal canal. The 
solution is very slowly injected by means of a hypodermic 
syringe with a specially constructed needle which is inserted 
into the spinal canal between two of the vertebrae. This 
produces anaesthesia in about 15 to 20 minutes over the 
entire surface of the body below the level of the point of 
injection. The effect produced is due to the action of the 
drug on the nerve trunks which enter the spinal cord. 

The drugs principally used for this purpose are cocaine, 
tropacocaine, and stovaine. Dangerous symptoms and even 
death may result from this method of anaesthesia. 



446 ■ MATERIA MEDICA 

LOCAL ANAESTHETICS USED BY DIRECT APPLICATION 

ETHER 

Ether is rarely used as a local anaesthetic, as its local 
effects last only for a very short time. It cools the skin by 
rapidly evaporating, and makes it insensible to pain. 

ETHYL CHLORIDE 

Ethyl chloride is most commonly used as a local anaes- 
thetic. It is usually sprayed on the skin, by means of a 
special glass container. It freezes the area over which it is 
sprayed by its very rapid evaporation, thereby producing 
local anaesthesia. The spraying should be stopped when 
the skin becomes white and hard, as it may injure the tissues 
if continued further. 

MENTHOL 

Menthol is a camphor-like substance (stearoptene) ob- 
tained from the oil of peppermint. It produced a feeling 
of coolness on the skin and mucous membranes, and pro- 
duces local anaesthesia. The anaesthesia is not sufficiently 
marked, however, to enable a surgical operation to be per- 
formed. It is used principally to relieve painful conditions 
of the skin. 

DILUTE HYDROCYANIC ACID 

(Dilute Prussic Acid) 

Dilute hydrocyanic acid is a 2% solution of pure hydro- 
cyanic or prussic acid. "It is formed by the combination 
of hydrochloric acid and silver cyanide. It is a colorless, 
inflammable fluid which evaporates very easily. Hydro- 
cyanic acid is the most poisonous substance laiown. The 
inhalation of its fumes causes instant death. Scheele, the 
chemist who discovered it, is said to have died in this manner. 

Bitter almonds, and the kernels of the seeds of various 
fruits such as peaches, cherries, apricots, plums and prunes, 
contain a glucoside, amygdalin and a ferment, emulsin. 



LOCAL ANAESTHETICS 447 

When the kernels of these fruits are rubbed in water, the 
emulsin changes the amygdahn to prussic acid, glucose (a 
sugar) and another substance. The syrup of wild cherry 
bark (syrupus pruni virginianae) also contains very small 
quantities of hydrocyanic acid. 

1. Applied locally to the skin or mucous membrane, it 
causes numbness by paralyzing the nerve endings of the 
sensory nerves. It is used for this effect to allay itching and 
to check nausea and vomiting. 

2. Given internally, it makes the breathing somewhat 
slower and shallower by lessening the impulses for breathing 
that are sent from the respiratory center. 

Dilute hydrocyanic acid is rarely used except as an in- 
gredient of cough mixtures to lessen the cough. 

Large doses affect the protoplasm of the cells so that it is 
unable to combine with oxygen and therefore causes severe 
poisonous symptoms. 

Hydrocyanic Acid Poisoning 

Hydrocyanic acid poisoning usually results when the acid, 
or any of its salts are taken with suicidal intent ; or from the 
inhalation of its fumes in a chemical laboratory. It is the 
most powerful poison known. 

Symptoms 

When a sufficiently large dose is taken, there is a slight 
convulsion and death results immediately from paralysis 
of the heart and respiration. 

If the dose has not been very large, the following symp- 
toms appear in a few seconds: 

1. Nausea and vomiting. 

2. The patient falls to the ground unconscious. 

3. Bloated face and frothing at the mouth. 

4. Dilated pupils. 

5. Protruding eyeballs. 

6. Very slow, shallow and irregular breathing. Often the 
expiration is prolonged, and followed by a long pause, during 
which the breathing seems to have stopped. 



448 MATERIA MEDICA 

7. Very weak and irregular pulse. 

8. Cyanosis. 

9. Odor of acid on the breath. 

10. Cold, moist skin. 

11. Convulsions, with clinching of the muscles of the 
fingers and toes. 

12. Paralysis of the muscles. 

Death usually results from paralysis of the respiration, 
within fifteen minutes. 

Treatment 

Rapid, vigorous treatment is necessary in order to save 
the patient. Usually, however, the symptoms appear so 
rapidly, that death results in spite of the most active treat- 
ment. If the patient can be kept alive for about twenty 
minutes to a half hour, the chances of recovery are increased, 
as most of the drug is then excreted. 

1. Wash out the stomach. 

2. Give artificial respiration continuously, as long as the 
patient is alive. This helps to eliminate the drug through 
the lungs. 

3. Apply cold applications to the head and spine to keep 
up the breathing. 

4. Iron hydroxide, peroxide of hydrogen or potassium 
permanganate are usually given to neutralize the acid. 

5. Heart and respiratory stimulants are usually given in- 
travenously, or hypodermically. 

Preparations 

Dilute Hydrocyanic Acid 0.1-0.5 c.c. m. ii-viii 

(Acidum Hydrocyanic um Dilutum) 

This contains 2% of hydrocyanic acid. It should always 
be fresh, as it decomposes very easily. 

Potassium Cyanide 0.005-0.008 gm. gr. ^^ 

(Potassii Cyanidum) 

This is a salt formed from hydrocyanic acid. It is not as 
poisonous as the acid, however. 



PART VII— SUBSTANCES WHICH IMPROVE NUTRITION 
CHAPTER XXV 

SUBSTANCES WHICH IMPROVE NUTRITION 

The substances used principally to improve nutrition 
may be divided into two groups: 

Medicinal Foods 
Alteratives 

Medicinal foods are preparations containing various pro- 
portions of the food principles. 

Alteratives are drugs which improve the nutrition of the 
body, or of various organs of the body. Their mode of 
action is unknown. They are said to improve the condition 
of the blood. 

MEDICINAL FOODS 

The following substances are used to improve the general 
health and strength of the body and to build up the tissues. 
They are not drugs, but food substances which are very 
easily digested and assimilated. Many of them are pre- 
digested, and these are of particular value in patients with 
very poor digestion. 

ACTION 

All the medicinal foods improve the health and strength, 
by helping to build up the tissues. They are often given 
together with various tonics; such as iron, arsenic, phos- 
phorus, etc. They consist largely of one or a number of the 
following food principles: 

Proteins 

Carbohydrates 

Fats 

Most of the preparations consist of combinations of 

449 



450 MATERIA MEDICA 

these food principles dissolved in alcohol, or glycerin, which 
serves only as a preservative. 

PROTEIN PREPARATIONS 

Solid Preparations 
CASOID DIABETIC FLOUR 

This consists of 85% of proteins obtained from milk, 
about 1J% of fat, and about 3% of mineral substances, 
while the remainder is water. 

It contains no carbohydrates or starchy foods, and is 
used in diabetes, where starchy foods should not be given. 

CIOSE 

Ciose is a dry powder made from beef. It contains about 
85% of proteins and has a great nutritive value. It is added 
to broths or soups, and is often given in wine. 

SOMATOSE 

Somatose is a powder which contains the proteins of meat 
in a very concentrated form. There are also other prepara- 
tions of somatose combined with iron and milk. 

SANATOGEN 

Sanatogen is a powder consisting of sodium glycerophos- 
phate combined with casein, one of the proteins of milk. 

DRY PEPTONOIDS 

Dry peptonoids is made by digesting beef, milk and wheat. 
The proteins of these foods are digested by pancreatin, and 
the carbohydrates, by malt diastase. It is given in doses 
of 8.0-16.0 c.c. (3ii-§i) in water, milk, wine, broths, soup 
and gruels. 

Liquid Preparations 

MEAT JUICES 

Meat juices are of two kinds: 

1. Cold meat juices. 

2. Warm meat juices. 



SUBSTANCES WHICH IMPROVE NUTRITION 451 

Cold Meat Juice 

Cold meat juice is made by chopping up lean meat from 
the round of beef, into fine pieces, and expressing their juice. 
This contains about 6% of the meat proteins and is very 
nutritious. 

Warm Meat Juice 

Warm meat juice is made by chopping up lean meat from 
the round of beef, expressing the pieces, and allowing them 
to remain in water in a warm place for about half an hour. 
There are numerous meat juices on the market made by 
various firms, such as Liebig's, Valentine's, etc. 

MEAT EXTRACTS 

The meat extracts contain very httle proteins, and are 
not very nourishing. They contain mostly extractives, 
such as various salts ; which make the patient feel better and 
increase the appetite. The most common beef extracts 
used are extracts made by various firms, beef teas and beef 
essences. 

LIQUID PEPTONOIDS 

Liquid peptonoids contains about 5% of proteins, and 
about 10% of carbohydrates, mainly various sugars. It is 
given in doses of 15.0-30.0 c.c. (Bj-i). 

ENEMOSE 

Enemose is a sterile liquid containing about 12% of pro- 
teins from beef and wheat, and about 45% of carbohydrates, 
mainly from wheat. 

It is used principally for rectal feeding. It usually comes 
in vials, the contents of one vial being dissolved in four 
parts of water and given by rectum. 

PEPTONE 

Peptone is obtained by the artificial digestion of protein 
substances such as meat. In large doses it is injurious to 



452 MATERIA MEDICA 

the tissues (irritating). It is given in pastilles in doses of 
5.0 gms. It is also given in suppositories for rectal feedingj 
or in nutrient enemas. 

PANOPEPTON 

Panopepton is prepared from beef and wheat by digesting 
them with pancreatin. The digested food is then dissolved 
in sherry wine. It is given in doses of 8.0-16.0 c.c. (5ii-§ J). 

NUTROSE 

Nutrose is sodium caseinate, a salt obtained from casein, 
one of the proteins of milk. It is particularly valuable in 
chronic wasting diseases such as cancer, tuberculosis, and 
in pneumonia and typhoid. 

PREDIGESTED LIQUID FOOD 

Predigested liquid food is prepared by artificially digest- 
ing lean meat and milk with pepsin and hydrochloric acid. 
It contains about 10% of proteins and about 10J% of 
carbohydrates. 

GELATINE 

Gelatine is an albumin like (albuminoid) substance de- 
rived from fibrous and cartilaginous tissue. It becomes 
solid when cool, and liquid when heated. It is an easily 
digested food. It helps to coagulate the blood, and is fre- 
quently used to check bleeding from the nose, the intestines, 
the kidney, etc. 

It may be applied locally to the bleeding area or it is given 
internally. 

Gelatine is frequently given hypodermically or in normal 
salt solution by means of a hypodermoclysis. The solution 
must ^ be absolutely sterile, as tetanus occasionally results 
from unsterile gelatine because of the tetanus bacilli con- 
tained in it. 

Internally, it is given in doses of 5i-ii, three or four times 
a day, or in the form of a jelly flavored, to taste better. 



SUBSTANCES WHICH IMPROVE NUTRITION 453 

Preparations 

Gelatine 4.0-8.0 c.c. Si-ii 

(Gelatinum) 

Glycerinated Gelatine 
(Gelatinum Glycerinatum) 

This is gelatine impregnated with an equal amount of 
glycerin. 

MILK FOODS 

The most important medicinal foods made from milk are 
kumyss and matzoon. 

KUMYSS 

Kumyss or koumiss, is a fermented Hquid prepared from 
mare's milk by the Tartars, who originated it. It is made 
from cow's milk in this country by fermenting milk with 
yeast. Liquid yeast is added to the milk, and the resulting 
fluid is then allowed to stand for about eight to ten hours 
in a lukewarm place. 

MATZOON 

Matzoon, or kefir kumyss is made by fermenting milk 
with a kefir fungus, a fungus obtained from Caucasia in 
Russia. It is on the market under various names such as 
matzoon, zoolak, etc. There are numerous other prepara- 
tions of milk made by growing bulgaric bacilli, which form 
lactic acid in the milk. They are principally used however, 
for the effect of the bulgaric bacilli which they contain and 
they will be considered under these preparations. 

There are numerous other predigested foods which are 
very often used in weakened conditions. The most im- 
portant ones are the following: 

Peptonized milk gruels 
Peptonized beef tea 
Peptonized oysters 
Pancreatized milk toast, etc., etc. 



154 MATERIA MEDICA 

CARBOHYDRATE PREPARATIONS 
GLUCOSE, DEXTROSE OR STARCH SUGAR 

Glucose or dextrose is the sugar which is present in the 
blood. The percentage of sugar in the blood is kept con- 
stant. It is usually about 0.08 to 0.12%. In certain dis- 
eases such as diabetes, the percentage of sugar in the blood 
is increased. 

Glucose solutions have the same effect on the circulation 
as normal salt solution, but they provide energy as well. 
If the percentage of sugar in the blood is increased, fluid is 
absorbed into the blood to lower it, and if the percentage 
is lowered fluid is eliminated through the kidneys to raise 
the percentage. 

When given by mouth glucose is digested by the saliva 
and pancreatic juice. It is then absorbed into the blood 
and helps to provide energj^ When given intravenously in 
concentrated solutions it acts as a diuretic, increasing the 
flow of urine. Such concentrated solutions increase the 
sugar content of the blood. Consequently fluid is absorbed 
into the blood until the percentage reaches the normal again. 
The excess of fluid is then eliminated by the kidneys, thus 
increasing the flow of urine. 

Uses 

Glucose is used as a food in cases of malnutrition in doses 
of 180.0 gms. (S vi) daily. In dilute solutions (3-10%) it 
is used in shock intravenously, or by rectum to provide 
fluid and at the same time energy. Dilute solutions are 
also given for the same purpose in uraemia, acidosis and 
other toxaemias. 

Concentrated solutions (10-50%) are given intravenously 
in nephritis to remove oedema which is accomplished by 
increasing the flow of urine. About 300 c.c. of such a solu- 
tion is injected three times a day. 

LEVULOSE OR FRUIT SUGAR (DIABETIN) 

Levulose is a sugar which is used to sweeten the food for 
diabetic patients who cannot take ordinary sugars. 



SUBSTANCES WHICH IMPROVE NUTRITION 455 

PREPARATIONS OF FATS 
COD LIVER OIL (OLEUM MORRHUAE) 

Cod liver oil is obtained from the livers of various species 
of codfish; especially the Gadus morrhua. 

It consists of the various fats : olein, stearin, and palmitin, 
and some fatty acids. It also contains very small quantities 
of iodine, chlorine, bromine, phosphorus, and other sub- 
stances. 

The livers were formerly allowed to decompose, and the 
oil thus formed was then collected. By a recent method, 
however, the cod liver oil is obtained by forcing steam under 
pressure through the livers, and collecting the oil. This oil 
is pale in color and less nauseating than the oil formed by 
the old method. There are three varieties of cod liver oil: 
the dark, the light brown, and the pale yellow. 

Cod liver oil was used for many years by the fishermen 
of the North Sea as a remedy for children's diseases. It is 
now very extensively used in medicine. 

ACTION 

Cod liver oil improves the general condition of the patient 
if given for some time. It increases the appetite, and it 
makes the patient stronger, stouter and healthier. Its 
effect depends largely upon the fats which it contains. These 
differ, however, from ordinary fats taken in the food, in 
being more easily digested, absorbed, and assimilated by 
the body. Cod liver oil is digested in the intestines, and is 
then deposited as fat in the various tissues and organs of the 
body, thereby building up the patient. 

In overdoses, it causes nausea; occasionally, vomiting and 
diarrhoea. 

Uses 

Cod liver oil is given principally in '^run down'' condi- 
tions, and in chronic wasting diseases, such as tuberculosis. 
It is often given together with malt or creosote. 

It is usually given only in winter ; patients dislike it during 
the summer months. 



456 • MATERIA MEDICA 

Administration 

The unpleasant taste and odor of cod liver oil can be dis- 
guised in the following ways : 

1. By giving the oil in brandy^ wine, or lemon juice, in the 
same way as castor oil (see castor oil). 

2. By taking a little peppermint, and then putting the 
cod liver oil in the mouth without allowing the lips to touch 
it, so that the smell does not reach the nose. 

3. By giving the emulsions of cod liver oil which have a 
more pleasant taste. They should be fresh, however, as 
they spoil very easily. 

All preparations of cod liver oil should be given about 
three quarters of an hour to an hour after meals, the time 
when most digestion takes place. 

In children, when it cannot be given by the mouth, cod 
liver oil may be rubbed on the skin of the chest or abdomen, 
before retiring, as it is readily absorbed from the skin. 

Preparations 

Cod Liver Oil 2.0-16.0 c.c. S^-iv 

(Oleum Morrhuae) 

Emulsion of Cod Liver Oil 4.0-16.0 c.c. 3i-iv 

(Emulsum Olei Morrhuae) 

This contains 50% of cod liver oil. 

Emulsion of Cod Liver Oil with 

Hypophosphites 4.0-8.0 c.c. 3i-ii 

(Emulsum Olei Morrhuae cum Hypophosphitibus) 

There are numerous preparations of cod liver oil on the 
market combined with preparations of phosphorus, iron, etc. 

LECITHIN 

Lecithin is a phosphorized fat. It consists of various 
salts of fatty acids such as oleic, stearic and pahnitic acids 
combined with glycero phosphoric acid and various protein 
substances. It is present in large quantities in nerve tis- 
sue. It is also present in various foods, especially in ^g 



SUBSTANCES WHICH IMPROVE NUTRITION 457 

yolk and many vegetable foods. For medicinal purposes, 
it is made from egg yolk. 

ACTION 

Lecithin increases the nutrition of the body, though it is 
not nourishing in itself. It increases the number of red 
blood corpuscles and the haemoglobin. It is used principally 
as a tonic. 

It is given by the mouth in doses of 0.1-0.5 gms. (grs. ij- 
viii) in pills, or hypodermically in doses of 1.0 c.c. (m. xv), 
or in 15% solutions in oil. 

Preparations 

Lecithin Solution 4.0 c.c. 5i 

(Containing gr. i of lecithin.) 

This is a 2% solution of lecithin in glycerin and alcohol. 
Its action and uses are the same as those of lecithin. 

Lecithol 4.0 c.c. 3i 

It is a 2% emulsion of lecithin in alcohol. It is obtained 
from the brains of hogs. 

Glycerole of Lecithin 4.0 c.c. 3i 

(Containing gr. i of lecithin.) 

Lecibrin 

This is obtained from the brains of animals and is com- 
bined with nucleoproteins. It contains 33% of lecithin. 
It comes in small gelatine coated ''pepules," each containing 
grs. iii which is equivalent to about gr. ^^ of phosphorus. 

Neuro Lecithin 0.1-0.5 gm. gr.-i^-viii 

This is a preparation of lecithin combined with small 
amounts of fats. 

ALTERATIVES 

Drugs which improve the condition of the blood, such as 
iron or arsenic, thereby also improve the nutrition oi the 
body. The drugs which improve the nutrition of the nervous 



458 MATERIA MEDICA 

system also improve the nutrition of various parts of the 
body. Most of these drugs, however, have other important 
actions and have been described under these effects. 

The following drugs are occasionally used ; but when given, 
they are used only as alteratives. 

PHOSPHORUS 

Phosphorus is a non-metallic element obtained from bones 
by the action of sulphuric acid and water. It is a semi- 
solid, soft, wax like, colorless or yellowish substance, which 
emits light in the dark, and has an odor of garlic. 

Phosphorus is found in the body in many tissues, espe- 
cially in nerve and bone tissue. In nerve tissue, phosphorus 
is present in large quantities combined with fats. These 
substances are called lecithins, or phosphorized fats. In the 
bones, phosphorus is combined with calcium, sodium, or 
magnesium. Phosphorus is also contained in many vege- 
tables. 

ACTION 

1. The principal effect of phosphorus is to increase the 
growth of bone. It increases the growth of bone forming 
cells (osteoblasts) and makes the spongy part of the bone 
(the cancellous tissue) more firm and hard. 

2. It slightly increases the formation of red blood cells 
but it does not increase the haemoglobin. 

3. It is said to improve the nutrition of nerve tissue by 
supplying them with their necessary phosphorus. The 
hypophosphites and glycerophosphates are the preparations 
used. 

Poisonous Effects 

Phosphorus poisoning occurs in two forms: acute poison- 
L2: and chronic Doisoning. 



ing and chronic poisoning. 



Acute Phosphorus Poisoning 

Acute phosphorus poisoning usually results from phos- 
phorus taken with suicidal intent. The red phosphorus is 



SUBSTANCES WHICH IMPROVE NUTRITION 459 

more poisonous than the yellow. Many pastes used to de- 
stroy vermin, or match heads which contain phosphorus, 
are the substances usually taken. 

Symptoms 

The following are the characteristic symptoms which ap- 
pear in about three to twelve hours. If an oily solution, or a 
paste is taken, they appear more rapidly; if the preparation 
is a solid one, they appear later. 

1. Abdominal pain. 

2. Nausea, vomiting and diarrhoea. 

3. The vomitus and stools, as well as the urine emit light 
when held in the dark and have an odor of garlic. 

4. Jaundice. 

5. Collapse and coma. 

All the symptoms of phosphorus poisoning are due to the 
destruction of many of the cells of some of the organs ol 
the body. The cell substances are changed to fat globules 
with which the cells become filled. For example, the jaun- 
dice is due to the broken up liver cells which block up the 
bile ducts in the liver, and the bile is then dammed back into 
the blood. The vomiting and diarrhoea with the bloody 
vomitus and bloody stools, are due to the destruction of 
the cells of the mucous membrane of the stomach and intes- 
tines. 

Death from phosphorus poisoning has resulted from 
grs. |-ii. It has occurred in a few hours to a few weeks. 

Treatment 

1. Old common crude turpentine, or French acid turpen- 
tine, about 2.0 c.c. (5^) every fifteen minutes is given as an 
antidote. This forms a hard solid mass with the phosphorus, 
and prevents its absorption. 

2. Occasionally hydrogen peroxide, or potassium per- 
manganate, may be given to oxidize the phosphorus. 

3. Copper sulphate may be given to produce vomiting. 
It is also an antidote, and is best given in two grain doses 
every five minutes, until vomiting is produced. After 



460 MATERIA MEDICA 

that gr. |- may be given every twenty minutes as long as 
ordered. 

4. Wash out the stomach. 

5. Give cathartics, especially salines such as hydrated 
magnesia. 

6. Protect the mucous membrane with albuminous drinks 
as the w^hite of egg, etc. 

7. Do not give oils or fats, as these hasten the absorption 
of the phosphorus. 

8. The collapse is treated with stimulants. 

Chronic Phosphorus Poisoning 

Chronic phosphorus poisoning usually occurs as a result 
of continually inhaling the phosphorus fumes, in individuals 
who work in phosphorus match factories. It occurs most 
frequently from the use of the yellow^ phosphorus, which 
has now mostly been given up, and the symptoms are there- 
fore now rarely seen. 

Symptoms 

The symptoms usually begin with a carious tooth, or a 
sore gum. The gums become swollen and painful, abscesses 
of the jaw often form, with destruction of pieces of the jaw 
bone. Occasionally there may be slight jaundice, anaemia, 
diarrhoea, albumin in the urine, etc. 

Treatment 

Thorough ventilation of the factories where phosphorus 
is used, to get rid of the fumes, and the inhalation of the 
crude turpentine, usually prevents the condition. 

When abscesses of the jaw form, they must be treated 
surgically. 

Uses 

Phosphorus preparations are used in the following con- 
ditions : 

1. In nervous diseases, such as neurasthenia, and other 
similar diseases, as a nerve tonic. 



SUBSTANCES WHICH IMPROVE NUTRITION 461 

2. To harden the bones in rickets, osteomalacia, etc. 

3. To increase sexual activity. 

Preparations 

Phosphorus 0.0005-0.0012 gm. gr. x^-sV 

(Phosphorus) 

Pills of Phosphorus 
(Pilulae Phosphori) 

Each pill contains 0.0006 gm. (gr. ji^) of phosphorus. 
Phosphorated Oil 0.06 -0.3 c.c. m. i-v 

(Oleum Phosphori ) 

This contains about 1% of phosphorus in almond oil and 
ether, and is occasionally used. 

The following preparations are made from phosphoric 
acid; which is formed when phosphorus is burned. 

Dilute Phosphoric Acid 0.3-1.0 c.c. m. v-xv 

(Acidum Phosphoricum Dilutum) 

This contains 10% of the pure phosphoric acid. 

From the phosphoric acid the following salts are obtained: 

f- 

Precipitated Calcium Phosphate 
(Calcii Phosphas Praecipitatus) 

This is rarely given alone, but in the form of an emulsion 
of cod hver oil and lactophosphate of calcium. Each si 
contains gr. ii of calcium phosphate and 5§ of cod liver oil. 

Zinc Phosphide 0.003-0.03 gm. gr. ^V"! 

(Zinci Phosphidum) 

The following preparations are made from hjrpophosphorus 
acid. 

Calcium Hypophosphite 0.5-2.0 gms. grs. viii-xxx 

(Calcii Hypophosphis) 

Iron Hypophosphite 0.5-2.0 gms. grs. viii-xxx 

' (Ferri Hypophosphis) 

Potassium Hypophosphite 0.5-2.0 gms. grs. viii-xxx 

(Potassii Hypophosphis) 

Sodium Hypophosphite 0.5-2.0 gms. grs. viii-xxx 

(Sodii Hypophosphis) 



462 MATERIA MICDICA 

Syrup of Hypophosphites 4.0-8.0 c.c. 5i-n 

(Syrupus Hypophosphitum) 

This contains the hypophosphite of calcium, sodium and 
potassium, also the tincture of lemon peel and sugar. 

Compound Syrup of Hypophos- 
phites 4.0-8.0 c.c. 5i-ii 
(Syrupus Hypophosphitum Compositus) 

This contains iron hypophosphite in addition to the 
ingredients in the syrup of hypophosphite. 

The following preparations are made from glycerophos- 
phoric acid: 

Calcium Glycerophosphate 0.2-0.6 gm. grs. iii-x 

(Calcii Gylcerophosphas) 

Various syrups and wines of glycerophosphates are on the 
market. Many of them are combined with iron. They are 
all good tonics. 

OTHER ALTERATIVES 

The Iodides and iodine preparations are frequently used 
to improve nutrition because of their ability to improve 
the action of many cells and to absorb newly forming con- 
nective tissue cells. 

Calcium salts are frequently given combined with phos- 
phorus or in the form of calcium lactate, to improve the nu- 
trition in nervous conditions; such as tetany, epilepsy and 
convulsions, and in rickets. These conditions are believed 
to be due to a deficiency of calcium salts. 

Thyroid Extract is frequently used to improve nutrition 
in cases where it is disturbed on account of a diminished 
secretion of the thyroid gland. 

Mercury and gold are metals which are believed to im- 
prove nutrition. 

MINOR ALTERATIVES 

The following group of drugs are occasionally used prin- 
cipally to improve the nutrition. 



SUBSTANCES WHICH IMPROVE NUTRITION 463 

SARSAPARILLA 

Sarsaparilla is obtained from the roots of Smilax offici- 
nalis, and other varieties of smilax. It is a prickly vine 
obtained from Mexico, Honduras, Brazil, and other coun- 
tries in the northern part of South America. Its active 
principles are soapy glucosides (saponins), sarsaponin, 
sarsaparilla saponin, parillin and smilacin, but their quan- 
tity is not sufficient to cause a marked effect. 

ACTION 

Sarsaparilla is used principally to improve the nutrition 
of the body (alterative). It is said to increase the perspira- 
tion. In large doses it causes vomiting and diarrhoea. It 
was formerly used a great deal in the treatment of the third 
stage of syphilis, chronic rheumatism, etc. It is occasionally 
used as a drink. 

Preparations 

Fluidextract of Sarsaparilla 2.0-4.0 c.c. m. xxx-5i 

(Fluidextractum Sarsaparillae) 

Compound Fluidextract of 

Sarsaparilla 2.0-8.0 c.c. m. xxx-5ii 

(Fluidextractum Sarsaparillae Compositus) 

This contains sarsaparilla, licorice root, sassafras and 
mezereum. 

Compound Syrup of Sarsa- 

pariUa 15.0-30.0 c.c. BH 

(Syrupus Sarsaparillae Compositus) 

This is used as an excellent vehicle in which to give 
potassium, iodide. 

GUIAC RESIN (GUIACUM RESINA) 

Guiacum is the resin of the wood of guiacum officinale 
and guiacum sanctum, evergreen trees of South America. 



164 MATERIA MEDICA 

ACTION 

Guiac is said to improve the nutrition of the body, to 
increase the secretion of sweat and the mucous membranes. 

Overdoses cause vomiting and diarrhoea. 

It is occasionally used in syphilis, tonsilitis, and is often 
given to increase the menstruation. 

Preparations 

Tincture of Guiac 2.0-8.0 c.c. 5^ii 

(Tinctura Guiaci) 

Ammoniated Tincture of Guiac 2.0-8.0 c.c. 3^ii 

(Tinctura Guiaci Ammoniata) 

Both of these preparations are best given in milk. 

MEZEREUM 

Mezereum is obtained from the bark of Daphne mezereum, 
a European plant. Its active principles are daphnin, a 
bitter glucoside, and an acid resin. 

Uses 

Mezereum is often applied on the skin in the form of the 
compound mustard liniment of which it is an ingredient, 
to produce redness. It is used internally as an alterative, 
in syphihs, etc. 

Preparations 

Fluidextract of Mezereum 0.6 c.c. m. x 

(Fluidextractum Mezerei) 

SASSAFRAS 

Sassafras is obtained from the bark of the Sassafras vari- 
foliorum. Its active principle is a volatile oil, the oil of 
sassafras. 

ACTION 

Sassafras is said to mildly improve the nutrition of the 
body (alterative). It also increases the sweat. It is often 
given together with sarsaparilla. 



SUBSTANCES WHICH IMPROVE NUTRITION 465 

The oil of sassafras is used as a flavoring agent, and as 
a perfume. 

Preparations 

Oil of Sassafras 0.06-0.3 c.c. m. i-v 

(Oleum Sassafras) 

STILLINGIA 

Stillingia is obtained from the Stillingia sylvatica, or 
queen's delight, an English plant. 

It slightly improves the nutrition of the body. It in- 
creases all the secretions, and is said to improve the heart 
action. 

In overdoses it causes vomiting and diarrhoea. It is 
occasionally used in syphilis and chronic rheumatism. 

Preparations 

Fluidextract of StUlingia 2.0-4.0 c.c. sH 

(Fluidextractum Stillingiae) 

XANTHOXYLUM 

Xanthoxylum is obtained from the bark of xanthoxylum, 
or prickly pear^ an American tree. 

It causes redness if applied locally. It is said to improve 
the nutrition of the body. It is often applied locally in 
pelvic diseases, together with tincture of capsicum. 

Preparations 

Fluidextract of Xanthoxylum 2.0-4.0 c.c. S^-i 

(Fluidextractum Xanthoxyli) 



PART VIII— DRUGS ACTING ON THE UROGENITAL 

TRACT 

CHAPTER XXVI 

DIURETICS 

(Kidney Stimulants) 

Physiology of the Kidneys 

The urine is secreted by the kidneys. The fluid part of the 
urine is formed by some of the fluid of the blood passing into 
the tubules of the kidnej^s at the glomeruh (where capillary 
blood vessel and tubule meet), which are situated at the cor- 
tex. In its passage along the tubules of the kidneys this fluid 
becomes filled with dissolved substances. These are ab- 
stracted from the blood by the direct action of the cells 
fining the tubules. 

Classification 

Diuretics are drugs which increase the flow of urine. 
They may be divided into the following four groups accord- 
ing to the method in which they increase the secretion of 
urine. 

1. Cell Stimulating Diuretics 

2. Irritant Diuretics 

3. Circulatory Diuretics 

4. SaUne Diuretics 

Cell Stimulating Diuretics are drugs which increase the 
flow of urine by directly making the cells of the kidney se- 
crete more urine from the blood, without injuring the cells 
themselves. 

Irritant Diuretics are drugs which increase the secretion 
of urine by irritating (injuring) the cells of the kidney and 
therefore making them secrete more urine from the blood. 

466 



DIURETICS 467 

In large doses these substances may cause inflammation 
of the kidney. 

Circulatory Diuretics are drugs which increase the secre- 
tion of urine by improving the circulation of the kidneys 
so that more fresh blood is constantl}^ being brought to them 
from which to form urine. This effect may result from 
the action of a drug on the heart, as from digitalis. It 
may also result from widening (dilating) the blood vessels 
of the kidneys so that the blood flows more freely through 
them and more urine is therefore able to be formed. The 
nitrites increase the secretion of urine in this manner. 

Saline Diuretics increase the secretion of urine in the 
following manner: Only the salts which are absorbed are 
able to increase the secretion of urine. When these salts 
enter the blood they increase its percentage of salt and 
the osmotic power of the blood is thus increased. As a re- 
sult, fluid is withdrawn from the tissues into the blood un- 
til the blood becomes filled with an excess of fluid. This 
excessive fluid then passes from the small blood vessels of 
the kidneys into the tubules, at the glomeruli (where blood 
vessels and tubules meet) thus increasing the secretion of 
urine. 

Diuretics may also be classified according to their chem- 
ical nature; as saline diuretics, alkaline diuretics, vegetable 
diuretics, etc. 

CELL STIMULATING DIURETICS 

CAFFEINE 

Caffeine increases the secretion of urine by directly in- 
creasing the action of the kidney cells and probably also by 
the improvement of the circulation. 



THEOBROMA (THEOBROMINE) AND DIURETIN 

Theobromine is a white powder, an alkaloid, obtained 
from the seeds of the Theobroma cacao, the chocolate tree 
of South America. It is very closely related, chemically, 
to caffeine. Its action is similar to that of caffeine. 



468 MATERIA MEDICA 

ACTION 

Local action: Theobromine has no effect when applied 
either to the skin or on mucous membranes. 

Internal Action 

In the mouth: It has a somewhat bitter taste. 

In the stomach and intestines: It increases the secretions 
and peristalsis; often causing nausea, vomiting and frequent 
movements of the bowels. 

Action after Absorption 

Theobromine and its salts are rapidly absorbed from the 
stomach; usually in about a half to one hour. After absorp- 
tion, they affect principally the heart, the muscles and the 
kidneys. 

Action on the heart: It makes the heart beat stronger and 
faster. It also contracts the blood vessels. The pulse is 
therefore stronger and faster. 

Action on the muscles: Theobromine increases the con- 
tractions of all the muscles. 

Action on the kidneys: Theobromine and its salts are 
excellent diuretics. They increase the flow of urine, by di- 
rectly increasing the activity of the kidney cells. In this 
way, they remove fluid from the tissues and from the abdo- 
men, reheving oedema of the extremities and ascites. 

Excrct-on 

Theobromine and its salts are rapidly eliminated from 
the body mainly by the kidneys; usually in a few horn's. 

Poisonous Effects 

Since theobromine is rapidly excreted, it very rarely pro- 
duces poisonous effects. When poisonous symptoms do 
occur, they are the same as those produced by caffeine. 

Administration 
Since theobromine and its salts are rapidly eliminated. 



DIURETICS 469 

they are best given in small doses, frequently repeated 
(about every two hours), when a continual effect is desired. 

Preparations 
All these preparations are not official. 

Theobromine 0.3-1.0 gm. grs. v-xv 

(Theobromina) 

This preparation is apt to upset the stomach. 

Theobromine Sodium Salicylate 0.3-1.0 gm. grs. v-xv 
(Theobrominae Sodii Salicylas) 
(Diuretin) 

This preparation is very frequently given as a diuretic, 
because it is more readily dissolved than the others. 

Theobromine Sodium Acetate 0.3-1.0 gm. grs. v-xv 

(Theobrominae Sodii Acetas) 
(Agurin) 

Theobromine and Lithium Benzoate 0.3-1.0 gm. grs. v-xv 
(Theobrominae et Lithii Benzoas) 
(Urophen B) 

Theobromine and Lithium Salicy- 
late 0.3-1.0 gm. grs. v-xv 
(Theobrominae et Lithii Salicylas) 
(Urophen S) 

THEOPHYLLIN 

Theophyllin is the active principle of tea leaves. Its ac< 
tion is similar to that of caffeine. It is occasionally used 
to increase the flow of urine. 

Preparations 

Theophyllin Sodium Acetate 0.2-0.3 gm. grs. iii-v 
(Theophyllinae Sodii Acetas) 

THEOCIN 

Theocin is artificial theophyllin. It is used to increase 
the flow of urine. 



470 MATERIA MEDICA 

Preparations 

Theocin 0.2-0.3 gm. grs. iii-v 

(Theocinae) 

IRRITANT DIURETICS 

The following drugs are obtained from various plants 
and act as diuretics. 



SCOPARIUS (BROOM TOPS) 

Scoparius is obtained from the dried tops of the Cytisus 
scoparius, or common broom plant, which grows in Europe 
and the United States. Its active principles are a fluid 
alkaloid, sparteine, and a neutral substance, scoparin. Its 
diuretic action is due to the scoparin. 

ACTION 

The principal action of scoparius is to increase the flow 
of urine, but its effect is not very marked, however. 

Preparations 

Scoparius is given in the form of a decoction, made by 
boiling about 15.0 gms. (§^) of broom tops in water; to 
make up 250.0 c.c. (i pint). About 30.0 gms. (§i) of this 
decoction is given every 2 or 3 hours. 

Sparteine, the alkaloid of scoparius, lessens the contrac- 
tions of involuntary muscles and weakens the heart action. 
It has been described more fully under these more important 
effects. 

JUNIPER 

Juniper is obtained from the unripe, full sized berries of 
the Juniper communis, or juniper plant. Its active principle 
is a volatile oil, the oil of juniper, which is obtained by 
distilling the berries. 

ACTION 

Local action : Juniper produces slight redness of the skin 
and mucous membranes if applied locally. 



DIURETICS 471 

Internal Action 

Taken internally: It increases the secretion of the stomach 
and intestines. It thereby increases the appetite and aids 
digestion. Its principal effect, however, is to increase the 
flow of urine. 

Poisonous Effects 

Overdoses of juniper usually cause painful urination with 
bloody urine. 

Administration 

Juniper is rarely given alone. It is usually combined 
with cream of tartar or other alkaline diuretics. 

Preparations 

Oil of Juniper 0.2-1.0 c.c. m. iii-xv 

(Oleum Juniperi) 

Spirits of Juniper 2.0-4.0 c.c. m. xxx-3i 

(Spiritus Juniperi) 

The most commonly used preparation, however, is the 
infusion of juniper berries. It is made by boihng an ounce 
of the berries in a pint of water, and is given in doses oi 
2.0 to 4.0 c.c. (3H)- 

UVA URSI (BEAR BERRY) 

Uva ursi is obtained from the leaves of the Arctostaphylos 
uva ursi, an evergreen shrub growing in northern Europe 
and the United States. Its active principles are the gluco- 
sides, arbutin and methylarbutin. It also contains an in- 
active glucoside ericolin, and small quantities of tannic and 
gallic acids. 

ACTION 

Because of the tannic and gallic acids which it contains, 
uva ursi contracts mucous membranes. 

The principal action of uva ursi, however, is to increase 
the flow of urine, by directly increasing the activity of the 
kidney cells. This effect is due to the arbutin. It also 
acts as an antiseptic on the mucous membrane of the ureter, 
bladder and urethra. 



472 MATERIA MEDICA 

Preparations 
Fluidextract of Uva Ursi 1.0-4.0 c.c. m. xv-5i 

(Fluidextractum Uvae Ursi) 

TRITICUM 

Triticum is obtained from the Agropyron repens, or couch 
grass, a gi'ass which grows in Europe and the United States. 

Triticum is said to increase the flow of urine. It is usually 
given in the form of a decoction; about 8.0-16.0 c.c. (5ii-iv) 
in a large tumbler full of water. 

Preparations 
Fluidextract of Triticum 2.0-8.0 c.c. sj-ii 

(Fluidextractum Tritici) 

MERCURY SALTS 

The following salts of mercury are often used to increase 
the flow of urine. 

Calomel 0.015-0.15 gm. grs. -^-ii 

(Hydrargyri Chloridum Mite) 

As a diuretic, calomel is often given in the form of Guy's 
or Fother gill's pill, which contains: 
Calomel 

Powdered squills 
Powdered digitalis, of each 0.06 gm. gr. i 

Bichloride of mercury, in small doses also increases the 
flow of urine. In poisonous doses, it causes severe destruc- 
tion of the kidney cells with lessened secretion of urine. 
Uraemia and death result from this condition. 

Cantharides and Turpentine Oil are principally used lo- 
cally, but they also increase the flow of urine. 

CIRCULATORY DIURETICS 

The following drugs increase the flow of urine by improving 
the circulation in the kidneys. The circulatory diuretics 
are of two kinds : heart stimulants and vaso dilators. 

The heart stimulants make the heart beat stronger so that 
the blood is kept circulating more freely. More blood is 
therefore brought to the kidneys more frequently, and the 
secretion of urine is increased. 



DIURETICS 473 

The vaso dilators are drugs which dilate the blood ves- 
sels of the kidneys, thus improving their circulation and in- 
creasing the secretion of urine. 

Heart Stimulants Acting as Diuretics 

Digitalis 
Strophantus 
Squills 
Apocynum 

For their effects see heart stimulants, page 218. 



Vaso Dilators Acting as Diuretics 

The following drugs increase the flow of urine by widen- 
ing the blood vessels of the kidneys, thus enabling the blood 
to flow more freely through these organs. The cells of the 
kidneys are then better able to secrete urine. 

The Nitrites 
Pituitary Extract 

THE NITRATES 

The nitrates are salts formed by the combination of nitric 
acid and an alkali. 

ACTION 

The nitrates are very cooling, and increase the flow of 
urine; and occasionally the secretion of sweat. 

Poisonous Effects 

Overdoses of the nitrates often cause the following symp- 
toms. 

1. Burning pain in the throat, and in the abdomen. 

2. Nausea and vomiting; the vomited matter often con- 
tains blood. 

3. Diarrhoea, with bloody stools. 

4. Profuse secretion of urine, or scanty urine. 

5. Great muscular weakness. 

6. Collapse, coma and death. 



474 MATERIA MEDICA 

Preparations 

Potassium Nitrate 0.3-2.0 gms. grs. v-xxx 

(Potassii Nitras) 

(Saltpeter) 

This preparation is the one which is commonly used. It 
is found in salt beds and caves in India and the United 

States. 

Sodium Nitrate 0.3-2.0 gms. grs. v-xxx 

(Sodii Nitras) 

SPIRIT OF NITROUS ETHER 

This preparation increases the flow of urine, if the skin 
surface is kept cool. It produces other important effects 
however, under which it has been considered. 

Spirits of Nitrous Ether or Sweet 

Spirit of Niter 2.0-16.0 c.c. m. xxx-5iv 

(Spiritus Aetheris Nitrosi) 

SALINE DIURETICS 

The following mineral salts are frequently used to increase 
the flow of urine. Many of them are salts of the alkalies and 
are used to produce other effects. 

ACTION 

The sahne diuretics affect principally the stomach, intes- 
tines and the kidneys. Most of them are readily ab- 
sorbed. 

Action in the stomach : Because of their alkaline reaction, 
diuretic salts neutrahze the acid in the stomach. 

Action in the intestines : Most of the saline diuretics also 
act as cathartics. They produce frequent fluid movements 
of the bowels. For this effect they must be given in some- 
what larger doses than for a diuretic effect. 

Action on the kidneys : The effect of the saline diuretics 
on the kidneys is to increase the flow of urine, and results 
from their absorption. They increase the salt concentration 
of the blood, and therefore its osmotic power. As a result, 



DIURETICS 475 

fluid is withdrawn into the blood from the tissues, and the 
fluid content of the blood is increased. This excess of fluid 
is then eliminated by the kidneys, thus increasing the secre- 
tion of urine. 

Administration 

The saline diuretics should be given well diluted in the 
morning when the stomach is empty. 

Preparations 

Salts of Potassium 
Potassium Acetate 0.06-0.6 gms. grs. i-x 

(Potassii Acetas) 

This is a salt of potassium and acetic acid. 

Potassium Bitartarate 0.6-4.0 gms. grs. x-5i 

(Potassii Bitartaras) 
(Cream of Tartar.) 

This is a salt of potassium and tartaric acid. It is usually 
given in hot water, flavored with lemon juice. It is rarely 
given alone, usually together with the infusion of juniper. 

Potassium Citrate 0.6-1.2 gm. grs. x-xx 

(Potassii Citras) 

This is not as unpleasant to take as the other potassium 
salts. It increases the secretion of sweat (diaphoretic ac- 
tion), as well as the secretion of urine. 

Solution of Potassium Citrate 15.0-30.0 c.c. 5 J-i 
(Liquor Potassii Citratis) 

This contains about 8% of potassium bicarbonate, and 
about 6% of citric acid. 

Effervescent Potassium Citrate 2.0-4.0 c.c. 3i-i 

(Potassii Citras Effervescens) 

This consists of potassium citrate 20%, potassium bicar* 
bonate and sugar. 

Effervescent Draught 
(Not official) 



476 MATERIA MEDICA 

This is made by adding 30.0 gms. (5i) of potassium bicar- 
bonate to 30.0 gms. (§i) of lemon juice. 

Other potassium salts which are occasionally used as 
diuretics, are potassium bicarbonate, potassium carbonate, 
potassium chlorate and potassium sulphate. 



Salts of Sodium 

The only salt of sodium that is used to increase the flow 
of urine, is sodium acetate. 

Sodium Acetate 0.6-4.0 gms. grs. x-5i 

(Sodii Acetas) 

Salts of Lithium 

The salts of lithium produce the same effects as the po- 
tassium salts. 

Their principal effect is to increase the flow of urine. 

They are said to dissolve crystals in the urine and to 
prevent the formation of stones in the kidney in this way. 



Preparations 




Lithium Benzoate 


0.3-1.0 gm. 


grs. v-xv 


(Lithii Benzoas) 






Lithium Carbonate 


0.3-1.0 gm. 


grs. v-xv 


(Lithii Carbonas) 






Lithium Citrate 


0.3-1.0 gm. 


grs. v-xv 


(Lithu Citras) 






Effervescent Lithium Citrate 


4.0-8.0 gms. 


3i-ii 


(Lithii Citras Effervescens) 






This contains citric acid. 


lithium carbonate, sodium bi- 


carbonate and sugar. 







Salts of Strontium 

Strontium lactate is the only salt of strontium which in- 
creases the flow of urine. 

Strontium Lactate 0.3-1.0 gm. grs. v-xv 

(Strontii Lactas) 



DIURETICS 477 

URINARY ANTISEPTICS ACTING AS DIURETICS 

The following drugs act as antiseptics in the kidney, 
bladder and urethra. They also increase the flow of urine. 

Urotropin 

Methylene Blue 

Buchu 

Oil of Erigeron 

Oil of Santal 

Copaiba 

Cubebs 

Matico 



CHAPTER XXVII 

DEUGS WHICH ACT ON THE UTERUS 

The drugs used principally for their effects on the uterus 
may be divided into the following three groups: 

Ecbolics or Oxytocics (Uterine Muscle Stimulants) 

Emmenagogues 

Uterine Sedatives (Uterine Muscle Depressants) 

Ecbolics or Oxytocics are drugs which are used to contract 
the uterus, and to expel its contents. 

Emmenagogues are drugs which are used to increase, or 
to cause menstruation, when its absence is due to causes 
other than pregnancy. 

^AHien these drugs are used to bring about menstruation 
in pregnancy, they must be given in poisonous doses. Se- 
rious and even dangerous symptoms may then result, such 
as excessive bleeding, sepsis, etc. 



OXYTOCICS 
ERGOT (ERGOTA) 

Ergot is a black parasitic fungus, which grows on the rye 
plant, Secale cereale, the fungus taking the place of the rye 
grain. 

The active principles are the alkaloids: ergotoxine, ergo tine 
and tyramine. 

Appearance of the Patient 

Ergot is usually given to patients for bleeding from the 
uterus, or to contract the uterus immediately after child- 
bhth. 

Within fifteen minutes to a half hour after a dose of a 
preparation of ergot is given, the patient usually complains 
of violent cramp-like pains in the lower part of the abdomen, 

478 



DRUGS WHICH ACT ON THE UTERUS 479 

particularly in the region of the uterus. If there has been 
bleeding from the uterus, this is gradually lessened. 

There may be nausea, and later, frequent movements of 
the bowels. The pulse is usually slow and strong. 

ACTION 

Local action : Ergot produces no effect on the skin. If it 
is given hypodermically, it is quite injurious to the tissues, 
and is apt to cause an abscess at the site of injection. On 
mucous membranes: It causes redness and swelhng, with 
profuse secretion of mucus. 

Internal Action 

In the mouth: Ergot has a very unpleasant taste; it often 
increases the flow of sahva because of the irritation of the 
mucous membrane of the mouth. 

In the stomach: All the preparations except the active 
alkaloids may cause nausea and vomiting. 

In the intestines: Ordinary doses lessen peristalsis. Poi- 
sonous doses increase the secretions and peristalsis of the 
intestines, causing frequent bowel movements. 

Action after Absorption 

Ergot is rapidly absorbed into the blood through the 
mucous membrane of the stomach and intestines. Its ef- 
fects usually appear within a half hour. After absorption 
it affects principally the uterus and the circulation. 

Action on the uterus: This is the most important action 
of ergot. Ergot increases the contractions of the uterus. It 
produces wavelike contractions of the uterine muscles, which 
expel the contents of the uterus. It does not always start 
uterine contractions, but it always increases them when 
they are once started. By contracting the uterus, ergot 
contracts its blood vessels and stops uterine bleeding. 

Action on the heart: Ergot makes the heart beat slower, 
principally as a result of its effects on the blood vessels. 

Action on the blood vessels: The blood vessels are made 
narrower, by the contractions of the small muscle fibers in 



480 MATERIA MEDICA 

their walls. The narrow blood vessels increase the blood 
pressure, and offer a greater resistance to the contractions 
of the heart, which are then stronger and slower. The pulse 
of ergot is therefore slow and strong. It is due to the ergo- 
toxine and tyramine. The effect is similar to that of epine- 
phrine or pituitary extract but is not as marked. 

Action on secretions: The secretion of sweat and milk 
is lessened. 

Excretion 

The exact mode of excretion of ergot is unknown, but it is 
probably eliminated by the bowels and kidneys. 

Poisonous Effects 
There are two forms of ergot poisoning: acute and chronic. 

Acute Ergot Poisoning 

Acute ergot poisoning is very rare and usually occurs from 
large doses of ergot, taken to produce abortion. 

Symptoms 

1. Cramp-like abdominal pain. 

2. Vomiting. 

3. Diarrhoea. 

4. Bleeding from the uterus. 

5. Abortion. 

6. Haemorrhages into the skin. 

7. Tingling and itching of the skin, or numbness. 

8. Collapse (rapid, weak pulse, cold skin, slow and shal- 
low breathing, etc.). 

There may be convulsions before death. 

Treatment 

1. Wash out the stomach. 

2. The collapse is treated with heart stimulants, such 
as caffeine, strychnine, etc. 

Chronic Ergot Poisoning 

Chronic ergot poisoning results from eating rye bregid 



DRUGS WHICH ACT ON THE UTERUS 481 

made from rye infected with the ergot fungus. This is more 
apt to occur in the rye growing during wet seasons. 

Ergot poisoning is very common in Russia and other 
northern countries, where a good deal of rye bread is eaten. 
In the mediaeval age plagues of ergot poisoning were quite 
common. 

There are two forms of chronic ergot poisoning: 

1. The Gangrenous form 

2. The Spasmodic form 

In some epidemics the gangrenous, and in others the spas- 
modic form predominates. 

Gangrenous Form 

This is due to the persistent contractions of many of the 
blood vessels. As a result, various parts of the body, such 
as the fingers, the toes, the ears or the tip of the nose may 
be deprived of their blood supply, and the part affected 
then dies or becomes gangrenous. 

Symptoms 

The limbs are first affected. The fingers and toes become 
cold, they lose their sensation, and become blue in color. 
Soon they become hard and shriveled up and fall off, without 
causing pain. Sometimes the gangrene spreads up over the 
extremities, and the forearm or leg may become gangrenous. 
Occasionally areas of gangrene may form in the internal or- 
gans. Ulcers in the stomach and intestines may occur, be- 
cause various areas of these organs are deprived of their cir- 
culation. Ulcers of the cornea of the eye may also result 
from the contraction of some of the small blood vessels lead- 
ing to the cornea. 

Nervous or Spasmodic Form 

The symptoms of this form are believed to be due to spasms 
of the muscles in some of the small blood vessels of the brain. 
The contraction of some of these vessels obliterates the circu- 
lation in certain areas of the brain, thus causing the various 
symptoms. Some of the symptoms remain permanently. 



482 MATERIA MEDICA 

Symptoms 

1. Weakness. 

2. Drowsiness. 

3. Headache. 

4. Dizziness. 

5. Itching, and a feehng as if something were creeping 
over the hmbs (formication). 

6. Temporary or partial bUndness. 

7. Painful cramps in the hmbs. 

8. Clonic convulsions, followed by epileptiform convul- 
sions. The mind remains clear after the attacks, but often 
the patient becomes insane. 

The treatment varies with the symptoms. 

Uses 

Ergot is used to contract the uterus, and to prevent or 
check uterine bleeding. It should always be given when the 
uterus is empty. 

In labor cases it should always be given after the third 
stage of labor; that is, after the placenta is expelled. If 
given before the placenta is entirely expelled, the contrac- 
tions of the uterus may cause pieces of the placenta to re- 
main in the uterus, which may become infected and cause 
sepsis. 

Ergot is frequently given to check bleeding from the 
lungs, from an ulcer of the stomach, from an ulcer of the 
intestines in typhoid fever, etc. The bleeding is checked by 
the contractions of the bleeding vessels. 

Ergotoxine and tyramine are used to increase the blood 
pressure. 

Administration 

Ergot has a very unpleasant taste which should always 
be disguised. It is best given after meals. 

When given hypodermically, it should be injected deep 
into the muscles, and the part should be massaged very 
thoroughly afterwards. 

Preparations 

Fluidextract of Ergot 2.0-8.0 c.c. 5^1 

(Fluidextractum Ergotae) 



DRUGS WHICH ACT ON THE UTERUS 483 

Wine of Ergot 10.0-20.0 c.c. 5ii|-v 

(Vinum Ergotae) 

This contains about 20% of ergot. 

Ergot preparations should always be fresh, as they change 
very readily and become inactive if kept for any length of 
time. 

There are a number of preparations of ergot on the market 
which are suitable for hypodermic use. There are other 
preparations which are not so nauseating and are more 
reliable than the usual preparations. Most of them are 
not official. 

New and Non-official Preparations 
Ergotoxine phosphate 0.0006-0.0012 gm. gr. yio - A 

This is one of the active principles of ergot and is given 
hypodermically. 

Ergotinine Citrate 0.0006-0.0012 gm. gr. xio- 5V 

(Ergotininae Citras) 

This is an alkaloid which is changed in the body to ergo- 
toxine. 

Tyramine 0.03 gm. gr. |- 

This is one of the active alkaloids of ergot; it is used to 
contract the uterus and to increase the blood pressure. 

Purified Extract of Ergot: 0.2-0.5 gm. grs. iii-viii 

Extractum Ergotae Purificatum 
(Bonjean's Ergotin) 

This is a purified extract of ergot about ten times as 
strong as ergot itself. It is often given hypodermically. 

Ergotole 0.3-2.0 c.c. m. v-xxx 

This is an excellent preparation made from specially cul= 
tivated Spanish ergot. It is about 2i times as strong as the 
fluidextract. It is suitable for hypodermic use. 

Ernutin 2.0-4.0 c.c. m. xxx-3i 

This is a reliable preparation of ergot, which has a pleas- 



484 MATERIA MEDICA 

ant taste. It is given hypodermically in doses of 0.3-0.6 c.c. 

(m. v-x). 

hypodermically 0.6-2.0 c.c. m. x-xxx 

by mouth 0.6-4.0 c.c. m. x-5i 

(Liquid Extractum Ergotae) 



Comutol 



HYDRASTIS (GOLDEN SEAL) 

Hydrastis is obtained from the roots and underground 
stems of Hydrastis canadensis, golden seal or yellow root. It 
is a small shrub growing in the United States. Its active 
principles are the alkaloids, hydrastine and berberine. 

Appearance of the Patient 

After giving hydrastis, or any of its alkaloids, the patient 
usually has a better appetite, and the bowels move more 
freely. If there has been bleeding from the uterus, this is 
gradually checked. The pulse is slow and strong. 

ACTION 

Local action: On the skin, hydrastis has no effect. Ap- 
plied to mucous membranes: It increases their secretions. 

Internal Action 

In the mouth: It has a bitter taste and increases the flow 
of sahva. 

In the stomach: It increases the appetite, and aids diges- 
tion by increasing the secretion of gastric juice, and the 
peristalsis of the muscle wall of the stomach. 

In the intestines : It increases the secretion and peristalsis, 
causing frequent movements of the bowels. 

Action after Absorption 

Hydrastis is slowly absorbed into the blood, mainly 
through the intestinal mucous membrane. After absorption, 
it affects principally the circulation, the involuntary muscles, 
especially the muscle fibers in the walls of the blood vessels, 
and the uterus. 



DRUGS WHICH ACT ON THE UTERUS 485 

Action on the Circulation 
On the heart: hydrastis makes the heart beat slower, by 

increasing the impulses for slowing the heart, sent from the 
medulla of the brain. It also slightly increases the contrac- 
tion of the heart muscle. 

On the blood vessels: It makes the blood vessels nar- 
rower by contracting the muscle fibers in their walls. This 
increases the blood pressure and helps to make the heart 
beat stronger. 

The total effect on the circulation is to make the heart 
beat slower and stronger, which causes a slow and strong 
pulse. 

Action on the uterus: Hydrastis contracts the uterus. It 
checks bleeding from the uterus by contracting the uterine 
blood vessels as well as the uterus itself. 

Action on the involuntary muscles: It contracts all the 
involuntary muscles, such as those of the intestines, of the 
iris, as well as those of the blood vessels. 

Hydrastis is said to increase the secretion of bile. 

Excretion 

Hydrastis and its alkaloids are mainly eliminated from 
the body by the kidneys. It is excreted very slowly, much 
slower than it is absorbed, so that cumulative symptoms 
often result from continual administration. 

Hydrastine 

The slow, strong pulse, the contractions of the blood ves- 
sels, the contractions of the uterus, and other involuntary 
muscles, are due to the action of hydrastine. 

Berberine 

The increased appetite, the increased secretions of the 
stomach and intestines are due to berberine; which is a 
simple bitter. This alkaloid is often found in many other 
plants used as simple bitters. 



486 MATERIA MEDICA 

Poisonous Effects 

Poisoning from hydrastis or from its alkaloids is extremely 
rare. In the few cases that have occurred the symptoms 
were the following: 

1. Vomiting. 

2. Headache. 

3. Dizziness. 

4. Difficult breathing. 

5. Slow, weak, irregular pulse. 

6. Convulsions. 

7. Collapse; and death from failure of breathing. 

Uses 

Hydrastis is used for the following effects : 

1. As a bitter, to increase the appetite and aid digestion 
by increasing the secretion of the gastric juice. 

2. To check uterine bleeding. 

3. For constipation, to make the stools more fluid in 
character. 

Preparations 

Fluidextract of Hydrastis 1.0-4.0 c.c. m. xv-3i 

(Fluidextractum Hydrastis) 

Tincture of Hydrastis 1.0-4.0 c.c. m. xv-3i 

(Tinctura Hydrastis) 

Glycerite of Hydrastis 1.0-4.0 c.c. m. xv-3i 

(Glyceritum Hydrastis) 

This is used principally to relieve inflammations of the 
mucous membranes. 

Hydras tine is rarely used, but an artificial alkaloid made 
from it, hydrastinine, is very frequently used. 

HYDRASTININE 

Hydrastinine is an artificial alkaloid made by oxidizing 
hydrastine. It produces the same effect as hydras tis, but 
it is more efficient and more lasting. 



DRUGS WHICH ACT ON THE UTERUS 487 

ACTION 

Hydrastinine markedly contracts the uterus and all the 
small blood vessels. As a result of the latter effect it in- 
creases the blood pressure. It is used to check uterine 
bleeding. 

Preparations 

Hydrastinine Hydrochloride 0.01-0.03 gm. gr. J-4 
(Hydrastininae Hydrochloridum) 

This is given hypodermically in solution, and by the 
mouth in pills or tablets. 

STYPTICIN (COTARNINE HYDROCHLORIDE) 

(not official) 

Cotarnine hydrochloride, or stypticin, is an artificial 
alkaloid, made by oxidizing narcotine, one of the alkaloids 
of opium. 

ACTION 

It contracts the blood vessels, and the uterus. 

It is principally used to check bleeding from the uterus; 
It is also used to check bleeding from other parts of the 
body, such as the lungs, the stomach, or the intestines, by 
contracting the blood vessels of these organs. Gauze soaked 
in cotarnine is very frequently used by dentists to check 
bleeding. 

Preparations 

Cotarnine Hydrochloride (Stypticin) 0.015-0.1 gm. grs. J-ii 
(Cotarninae Hydrochloridum) 

It is given hypodermically in solution, or by the mouth in 
pills or tablets. 

Cotarnine Phthalate (Styptol) 
(Cotarninae Phthalas) 

Hypodermically 0.2 gm. (grs. iii) dissolved in 2.0 c.c. (m. xxx) of 
water. 

By mouth, 3 to 5 tablets a day. Each tablet contains gr. 
of the drug. 



488 MATERIA MEDICA 

PITUITARY EXTRACT (not official) 

Pituitary extract or pituitrin, is an extract of a small 
gland, situated at the base of the brain. It causes marked 
contractions of the uterus in about half an hour after it is 
given. The contractions usually last for several hours. 

It is used to check bleeding from the uterus and to cause 
uterine contractions after labor. 

This substance produces other more important effects. 
(See page 239.) 

It should be given hypodermically. 

Preparations 

Pituitary Extract 1.0 c.c. m. xv 

In small glass vials. 

Pituitrin 1.0 c.c. m. xv 

In small glass vials, for hypodermic use. 

QUININE 

Quinine is used to increase uterine contractions. It has 
other more important actions, however, under which it will 
be described. 

EMMENAGOGUES 

Emmenagogues are drugs which increase menstruation. 

Many drugs, such as iron, arsenic, or strychnine, which 
improve the general condition of the patient, will increase 
menstruation. 

Many cathartics, such as castor oil or aloes, when given in 
large doses, and all the drastic purgatives, will increase 
menstruation. 

Counterirritants, such as mustard or cantharides, when 
taken internally, will also increase menstruation. 

The substances used principally to increase menstrua- 
tion, however, all contain volaciie oils which are their active 
principles. These volatile oils are responsible for the follow- 
ing severe poisonous s3rmptoms that result from large doses. 



DRUGS WHICH ACT ON THE UTERUS 489 

Poisonous Symptoms of Volatile Oil Emmenagogues 

1. Abdominal pain. 

2. Nausea and vomiting. 

3. Profuse diarrhoea with bloody stools, 

4. Abortion. 

5. Scanty, bloody urine. 

6. Convulsions. 

7. Unconsciousness. 

8. Collapse. 

Volatile Oil Emmenagogues and Their Preparations 
OIL OF PENNYROYAL (OLEUM HEDEOMAE) 

The oil of pennyi'oyal is a volatile oil obtained from the 
leaves and tops of Hedeoma pulegioides, or the pennyroyal 
plant. 

It is used to expel gas from the intestine and to increase 
the menstrual flow. It is not a very active drug, but it is 
a common household remedy. 

Preparations 

Oil of Pennyroyal 0.06-0.3 c.c. m. i-v 

(Oleum Hedeomae) 

APIOL 

Apiol is an oily liquid (a stearoptene) , obtained from the 
root of ordinary garden parsley or Apium petrosinellum. It 
resembles camphor and is often called parsley camphor. 
Its active principle is said to be a substance called apioline. 

Apiol is used to increase the menstrual flow, especially 
when the scanty menstruation is due to anaemia and when 
the menstruation is painful. 

Preparations 

Apiol 0.2-0.6 gm. grs. iii-x 

Apioline 0.2-0.5 gm. grs. iii-viii 

Apiol is given in capsules; most of which are imported 
from France. Each capsule contains 0.25 gm. (grs. iv). 
There are a number of preparations of apiol combined with 
ergot and other substances. 



490 INIATERIA MEDICA 

GOSSYPIUM (COTTON ROOT BARK) 

Gossypium cortex is the dried bark of the ordinary cotton plant. 
Gossjrpium herbaceum. 

It has been used by the Southern negroes to produce abor- 
tion. It is occasionally used as a substitute for ergot, to 
contract the uterus and to check uterine bleeding. 

Preparations 
Gossypii Cortex 2.0 gms. grs. xxx 

UTERINE SEDATIVES 

The following drugs are used principally to lessen contrac- 
tions of the uteruS; and to relieve painful menstruation. 

VIBURNUM PRUNIFOLIORUM (BLACK HAW) 

Viburnum is obtained from the root of the Viburnum 
prunifoliorum or black haw, a small American plant. 

ACTION 

It lessens the contractions of involuntary muscles, espe- 
cially the muscles of the uterus. It soothes uterine con- 
tractions, and is said to check colic and cramps. 

It is used principally to relieve painful or excessive menstrua- 
tion, and to relieve the pains of ovarian disease. 

Preparations 
Fluidextract of Viburnum Pruni- 
foliorum 2.0-16.0 c.c. 5 Hv 
(Fluidextractum Viburni Prunifolii) 

VIBURNUM OPULUS (CRAMP ROOT) 

Viburnum opulus, or cramp root, is obtained from the 
bark of the Viburnum opulus, a small American tree. 

It acts like viburnum prunifoliorum, but is less soothing 
to the uterus and is said to relieve colic and cramp-like pains, 
more than viburnum prunifoliorum does. 

Preparations 
Fluidextract of Viburnum Opulus 2.0-16.0 c.c. 5 i-iv. 
(Fluidextractum Viburni Opuli) 



DRUGS WHICH ACT ON THE UTERUS 491 

There are a number of drugs which lessen, or soothe 
uterine contractions, but which have other more important 
effects. The most common of these are the following: 
Morphine 
Atropine 

Antipjnetic group 
(Acetanilid) 
(Antipjrrine) 
(Phenacetine) 
(Pryamidon) 



PART IX— SPECIFICS 



CHAPTER XXVIII 



SPECIFICS 



Specifics are drugs which are principally used to cure a 
particular disease. This effect is produced by destroying or 
neutralizing the causative agent of that disease. The best 
example of this action is the effect of quinine in malaria. 
The organism which causes this disease is destroyed by the 
quinine. 

Many of the specifics relieve the symptoms of a particular 
disease, though the mode of action may be unknown. An 
example of such an action is the effect of the salicylates in 
rheumatism. 

CINCHONA AND QUININE 

Quinine is a white powder, an alkaloid, the active princi- 
ple of cinchona, or peruvian bark. This is the bark of the 
cinchona tree, which grows in the Andes or other mountain- 
ous districts on the western coast of South America. The 
tree has been cultivated successfully, however, in other parts 
of the world, as in India and Java. There are two kinds of 
cinchona: Cinchona rubra, or red bark, and Cinchona cal- 
isaya, or yellow bark. They both produce the same 
effects, but the yellow bark contains more quinine. 

Cinchona is named in honor of the Countess of Cinchon, 
a Spanish countess who was cured in 1638, of a disease that 
was then known as the ague, but what we now know to be 
malaria. The drug had just been introduced in medicine 
at that time. It was brought to Spain by the Spanish 
explorers who learned of its use from the South American 
Indians. Besides quinine, the active alkaloid, cinchona con- 
tains the alkaloids, quinidine, conquinine, cinchonine, and 

492 



SPECIFICS 493 

cinchonidine. They resemble quinine in their effects; which 
are weaker, however. 

Appearance of the Patient 

When quinine is given to a patient suffering from malaria, 
it prevents the chills, fever and sweats, which are character- 
istic of that disease. 

After administration of a single average dose of quinine, 
the patient usually complains of a bitter taste in the mouth, 
he feels brighter, and the pulse is perhaps somewhat more 
rapid and stronger. If there is temperature, it is lowered 
several degrees. 

If the quinine is given for some time, the patient feels 
better, he has a better appetite, his bowels move more 
regularly, he feels brighter and stronger and is more active. 
The pulse is somewhat stronger and more rapid, the 
breathing is deeper and somewhat more rapid. 

ACTION 

Quinine affects all living tissues (protoplasm) . It increases 
their activities at first, but soon lessens them. All the effect? 
of quinine are due to this action. Quinine has no selective ac- 
tion on any particular organ or tissue. 

It destroys various living organisms such as amoebae, 
bacteria, etc. 

Local action: Applied to the skin or mucous membranes, 
quinine causes slight redness and acts as an antiseptic. It 
is not generally used as an antiseptic, because it is too ex- 
pensive. It is said to increase the growth of hair and 
therefore forms an ingredient of many hair tonics. 

Internal Action 

In the mouth: Because of its very bitter taste quinine in- 
creases the appetite and the secretion of saliva. 

In the stomach: It lessens the action of pepsin, thus re- 
tarding the digestion of protein food. In large doses, it 
occasionally causes nausea and vomiting. 

In the intestines: It retards the action of the trypsin of 



494 MATERIA MEDICA 

the pancreatic juice, and increases the secretions and peri- 
stalsis, often causing frequent movements of the bowels. 

Action after Absorption 

Quinine is slowly absorbed into the blood, principall}^ 
from the stomach. The presence of acid in the stomach 
aids the absorption. It begins to be absorbed in about 15 
minutes, but the absorption is not complete until about four 
or five hours. When it enters the blood, it acts as a specific 
for malaria, and it slightly affects the nutrition and the 
action of all the tissues and organs. 

Specific Action in Malaria 
Malaria 

Malaria is a disease caused by a unicellular organism, a 
protozoan called the Plasmodium malariae. This organism is 
injected into the blood of the patient, when an individual 
is bitten by a species of mosquito, the anopheles. The organ- 
isms then enter the red blood corpuscles, where they grow 
and develop into other similar organisms in 48 or 72 hours, 
depending on the t}^e of organism. At the end of this time, 
the red blood corpuscles burst, the newly formed malarial 
parasites and poisonous substances, together with the hae- 
moglobin of the red blood corpuscles, are thrown into the 
blood. 

As a result of the sudden destruction of a large num- 
ber of red blood corpuscles, and the hberation of poisonous 
substances, the patient has a chill. The violent muscular 
contractions which are thus produced, elevate the tempera- 
ture several degrees, and since this temperature is excessive, 
it is followed by sweating, which gradually reduces it to 
normal again. 

These chills, fever and sweats occur every other day, if the 
organism which causes these symptoms is the tertian type, 
or the one which develops in 48 hours. They occur every 
third day, if the organism is the quartan type or the one which 
develops in 72 hours. In some cases, the chills, fever and 
sweats occur every day. This is due to the fact that the 



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Effect of quinine on malarial parasites. (Note the disin- 
tegration of the parasites and the diminution of the red 
granules.) 
1 and Microscopical Diagnosis. 



::!li 



.»M 



■'■> aoimmuiiu iDiu mm '^f^iammi wd^ to noimi'go^ 



SPECIFICS 495 

patient is infected with two types of tertian organisms, each 
one developing every 48 hours, but on alternate days. The 
attacks always occur regularly at about the same time during 
the day. 

Effect of Quinine in Malaria 

If a patient suffering from malaria is given quinine, the 
quinine enters the blood and destroys the plasmodiae. The 
chills, fever and sweats are then prevented, and the disease 
is cured. The use of quinine must be continued for some 
time, however, even after the symptoms have disappeared ; 
until all the plasmodiae in the blood are destroyed, and the 
patient is free from attacks. 

Effect on nutrition and metabolism: Quinine increases the 
nutrition of the tissues and organs of the body, by prevent- 
ing the nitrogenous, or protein food from being used up 
(combining with oxygen). These foods help to build up 
the patient and conserve the strength. In this way quinine 
acts as a tonic, slightly improving the action of all the tissues 
and organs of the body and making the patient feel better 
and stronger. 

Action on the blood: Besides its destructive action on 
malarial parasites, quinine prevents the red blood corpuscles 
from taking up oxygen as readily as before. It also lessens 
their number and checks the movements of the white blood 
corpuscles. 

Action on the circulation: The pulse is made somewhat 
stronger and faster, because the contractions of the heart 
and blood vessels are increased. Large doses occasionally 
cause a slow and weak pulse because of the slightly weak- 
ened contractions of the heart. 

Action on the nervous system: Quinine lessens nervous- 
ness and neuralgic pains. 

Action on the senses of sight and hearing: Large doses 
of quinine very frequently cause ringing in the ears, and 
dimness of vision. 

Action on the uterus: Quinine increases the contractions 
of the uterus during labor; it occasionally causes abortion. 

Effect on temperature: The temperature is lowered be- 



496 MATERIA MEDICA 

cause oxidation of the nitrogenous or protein substances 
of the tissues is lessened, and less heat is produced. 

Excretion 

Quinine is eliminated from the body by the urine, mostly 
in about 6 to 8 hours. 

Idiosyncrasies 

Many individuals are especially susceptible to quinine, 
even small doses causing poisonous effects. In some in- 
dividuals, the following unusual symptoms occur, even from 
very small doses: 

1. Eruptions on the skin, such as areas of redness re- 
sembling the scarlet fever rash, hives or urticaria, and oc- 
casionally small bhsters. (Herpes.) 

2. Occasionally scanty urine, accompanied by pain; often 
the urine is tinged with blood or haemoglobin. 

3. Slow and weak pulse, and a feeling of weakness. 

Poisonous Effects 

Since quinine is very frequently given in large doses for 
malaria, poisonous effects are not uncommon. These effects 
result from continued use of quinine, or from very large 
doses taken to produce abortion. While the symptoms which 
result may be alarming, they are rarely, if ever, fatal. 

Symptoms 

The first and most characteristic symptom of quinine 
poisonmg is: 

Ringing in the ears, or roaring sounds in the ears. 
Often the patient may become temporarily deaf. Rarely 
the deafness remains permanent. 

2. Dimness of vision, especially for colors. 

3. Temporary blindness or ''color blindness.'' The blind* 
ness is occasionally permanent. 

4. Nausea and vomiting. 

5. Slow, weak pulse. 

6. Muscular weakness, 

7. Collapse. 



SPECIFICS 497 



Treatment 



The symptoms usually subside when the drug is stopped. 
If they do not disappear, they are usually relieved by bro- 
mides. If the pulse is weak, caffeine, given hypodermically; 
or a hot coffee enema, usually improves it. 

Uses 

Quinine is used principally in the following conditions: 

1. As a specific in malaria. 

2. As a bitter, to increase the appetite; and as a tonic to 
improve nutrition. 

3. To reduce fever. 

4. To destroy the amoebae, unicellular organisms which 
cause amoebic dysentery, a chronic disease of the intes- 
tines. In these cases quinine is usually given by irrigations 
into the colon or large intestine. 

Administration 

In malaria, quinine is usually given in one single large 
dose of 1.0 gm. (grs. xv) about 4 hours before the time when 
the chill should occur. It may also be given in divided 
doses, so that the last dose is given about the time of the 
expected chill. By the time the quinine enters the blood, 
the parasities are very young and are readily destroyed. It 
may also be given in divided doses when the temperature 
is going down, after the chill. The administration of quinine 
should be kept up, however, for about a week after the 
attack is over, to prevent a recurrence of the symptoms. 

1. Quinine is best given in solution after meals, since 
the presence of acid in the stomach aids the absorption. 
The addition of a drop of dilute sulphiu"ic acid to the fluid 
will also aid the absorption. 

Quinine is frequently given in the form of powders or 
pills. The pills are usually not very efficient unless they 
are fresh. Old quinine pills may pass out in the stools with- 
out being absorbed. The addition of a few drops of dilute 
sulphuric acid usually makes the quinine preparation more 
soluble. 



498 MATERIA MEDICA 

2. On account of its unpleasant, bitter taste, quinine 
should be given in sherry wine, in cachets or capsules, or 
some food, such as olive oil, may be given afterwards. 

3. For its bitter effect it should be given before meals in 
fluid form, undiluted. 

Preparations 

Cinchona 

Fluidextract of Cinchona 1.0-4.0 c.c. m. xv-5i 

(Fluidextractum Cinchonae) 

Tincture of Cinchona 4.0-16.0 c.c. 3 i-iv 

(Tinctura Cinchonae) 

Compound Tincture of Cinchona 2.0-4.0 c.c. 5 i-i 
(Tinctura Cinchonae Composita) 

The cinchona preparations are used principally as bitters 
to increase the appetite. For malaria and as a tonic, quinine 
preparations are preferable. 

Quinine 
Quinine 0.3-1.0 gm. grs. v-xv 

(Quinina) 

Quinine Bisulphate 0.3-1.0 gm. grs. v-xv 

(Quininae Bisulphas) 

This is the most common preparation used, as it is the most 
soluble one. 

Quinine Sulphate 0.3-1.0 gm. grs. v-xv 

(Quininae Sulphas) 

Quinine Hydrobromide 0.3-1.0 gm. grs- v-xv 

(Quininae Hydrobromidum) 

Quinine Hydrochloride 0.3-1.0 gm. grs. v-xv 

(Quininae Hydrochloridum) 

Other Alkaloids of Cinchona 

Cinchonine Sulphate 0.5-1.3 gm. grs. viii-xx 

(Cinchoninae Sulphas) 

Cinchonidine Sulphate 0.5-1.3 gm. grs. viii-xx 

(Cinchonidinae Sulphas) 



SPECIFICS 499 

Compound Preparations 

Iron and Quinine Citrate 0.3-0.6 gm. grs. v-x 

(Ferri et Quininae Citras) 

Syrup of Iron, Quinine and Strychnine 

Phosphate 4.0 c.c. 5 i 

(Syrupus Ferri, Quininae et Strychninae Phosphatum) 

Elixir of Iron, Quinine and Strychnine Phosphate 

4.0 c.c. 5 i 

(Elixir Ferri, Quininae et Strychninae Phosphatum) 

Warburg's Tincture 

This is a dark brown liquid which is used extensively in 
India, in the treatment of malaria. It contains a large 
number of ingredients besides quinine, such as aloes, rhubarb, 
gentian, camphor, etc. 

New and Non-official Preparations 

Quinine and Urea Hydrochloride 0.3-1.0 gm. grs. v-xv 
(Quininae et XJreae Hydrochloridum) 

This preparation is suitable for hypodermic use. It is 
also used as a local anaesthetic injected hypodermically or 
applied to mucous membranes. 

Quinine Tannate 0.6-2.0 gms. grs. x-xxx 

(Quininae Tannas) 

This preparation is slowly absorbed, and has no bitter 
taste. 
Aristochin 0.3-1.0 gm. grs. v-xv 

This is a chemical derivative of quinine. It is not so apt 
to cause poisonous symptoms. 

Euquinine 0.3-1.0 gm. grs. v-xv 

(Quininae Aethylcarbonas) 

This is a chemical derivative of quinine, which is tasteless. 

Chinaphenin 0.3-0.6 gm. grs. v-x 

This is a compound of quinine and phenacetine. It com- 
bines the quinine action with the anodyne effect of phenace- 
tine. It is tasteless and is not apt to cause poisonous symp- 
toms. 



500 MATERIA MEDICA 

Quinine Lygosinate 
(Quininae Lygosinas) 

This is a chemical derivative of quinine. It is used as an 
antiseptic dusting powder, or in solution to check bleeding. 

Saloquinine 0.5-2.0 gms. grs. viii-xxx 

This combines the action of quinine with saUcylic acid. 
Saloquinine Salicylate 1.0 gm. grs. xv 

This acts like saloquinine. 

ETHYLHYDROCUPREINE (OPTOCHIN) 

Optochin or Ethylhydrocupreine is a substance obtained 
from the Cuprea bark, the bark of a Chinese plant. It 
is also made from hydroquinine, a substance made from 
quinine. Ethylhydrocupreine acts hke quinine. It has, how- 
ever, a specific destructive action on pneumococci, the bac- 
teria which cause pneumonia. It has therefore been used 
in recent years as a specific for pneumonia. 

It is applied locally in 1% solutions to local infections 
caused by the pneumococci such as certain forms of corneal 
ulcers in the eye. 

It is given in pneumonia as a specific. The treatment is 
begun by giving 0.5 gm. (grs. viii) as an initial dose, followed 
by 0.15 gm. (gr. ii|^) ever^^ 3 hours until 1.5 gm. (grs. xxiii) 
has been given in twenty four hours. The best results are 
obtained when the drug is given early in the disease as other- 
wise the pneumococci become resistant to it. It is also 
given hypodermically in solution or in oil. 

Poisonous Effects 

Ethylhydrocupreine is particularly apt to cause poisonous 
symptoms which are those of quinine poisoning. It is es- 
pecially apt to cause eye symptoms however, even blindness. 

Preparations 

Ethylhydrocupreine hydrochloride 
Ethylhydrocupreinae hydrochloridum 
(Optochin) 



Sl^ECIFICS 501 

PHLORIDZIN (not official) 

Phloridzin is a glucoside obtained from the roots of the 
apple, pear, cherry, and other trees. 

It is occasionally used to destroy malarial parasites. It 
forms sugar in the urine and increases its secretion. Be- 
cause of its irritating effect on the kidneys, it is rarely used, 
except to test the action of the kidneys. 

Preparations 

Pliloridizin 0.3-0.6 gm. grs. v-x 

(Phloridizinum) 

Methylene blue is also occasionally used as a specific 
for malaria. 

MERCURY (HYDRARGYRUM) 

Mercury or quicksilver is a silver-colored liquid metal 
which evaporates very easily. Many of its salts are used 
in medicine. 

Appearance of the Patient 

A few hours after giving an average dose of a preparation 
of mercury, the patient usually has several movements of 
the bowels and more urine is passed. The stools are soft, 
colored with bile, and accompanied by a little griping. Oc- 
casionally the flow of saliva is also slightly increased. 

If small doses of mercury preparations are given contin- 
uously for weeks or longer, to a patient suffering from the 
first or second stage of syphilis, the symptoms, such as the 
original ulcer or chancre, the rash on the body, the mucous 
patches in the mouth, and the sweUing of the glands, all 
gradually disappear. 

ACTION 

The salts of mercury combine with the proteins and 
albiunins of all living matter, forming an albuminate of 
merciuy. It is therefore injurious to, and may even destroy 
living cells. In this way, it checks the growth of bacteria 
(antiseptic action), and other living organisms and parasites 
(antiparasiticide) . 



502 MATERIA MEDICA 

Local action: Applied to the skin, mercury preparations 
are excellent antiseptics. If a strong solution is used, or 
even a weak solution continuously, redness, pain and itching 
of the skin will result. If a strong solution is kept in contact 
with the skin for a long time, inflammation and even destruc- 
tion of the skin may result. 

Mucous membranes are shrunk and contracted by the 
action of mercury preparations (astringent action). 

Internal Action 

In the mouth: Mercury preparations have a distinct metal- 
lic taste, and contract the mucous membranes. 

In the stomach: They slightly increase the secretions, 
occasionally causing nausea. 

In the intestines: Mercury preparations increase the 
secretions and peristalsis, causing frequent soft stools stained 
with bile. They also act as intestinal antiseptics. The large 
quantity of bile in the stools which results from prepara- 
tions such as calomel, is due to the antiseptic action, which 
prevents the decomposition of the bile, and to the increased 
peristalsis of the bile ducts which accelerates its flow. Mer- 
cury preparations do not increase the secretion of bile, as 
was formerly supposed. The preparations of mercury, such 
as calomel, which are not readily absorbed, are the best ones 
to use as cathartics. 

Action with Absorption 

Mercury salts are readily absorbed into the blood from all 
the mucous membranes, from the lungs, and even by the 
skin. When given by mouth, they are absorbed in 1 to 2 
hours. After absorption, they affect principally the intes- 
tines, the kidneys, some of the secretions, the nutrition of 
the tissues, and if given steadily, they act as a specific for 
the first and second stages of syphilis. 

Action on the kidneys: Mercury salts increase the flow of 
urine. 

Action on the secretory glands: All the secretions, espe- 
cially the saliva and pancreatic juice, are increased. 



SPECIFICS 503 

Action on nutrition: Small doses of mercury preparations, 
if given for some time, increase the nutrition of the tissues, 
and the body weight. (Alterative action.) 

Specific Action in Syphilis 
Syphilis 

Syphilis is a chronic infectious disease, caused by the 
Spirochaeta pallida, a spiral shaped organism. The infection 
begins with the formation of a hard ulcer, or chancre, usually 
on the genital organs. This is known as the first stage of 
the disease. It is followed in about six weeks, by an erup- 
tion all over the body (roseola), whitish patches in the 
mouth (mucous patches), and swelling of all the lymph 
glands throughout the body. This is known as the second 
stage of the disease. Some time later, in several months 
or years, or at any time during the patient's lifetime, he 
may suffer from various diseases, which result from the for- 
mation of gummata. Gummata are areas of round cells which 
readily decompose, forming a thick fluid in the center. Any 
organ of the body may be affected in this way, producing 
many and varied symptoms. The occurrence of these late 
symptoms is known as the third stage of the disease. 

Parents infected with syphilis may transmit the disease 
to their children. The children may be born dead, or 
they may suffer, if they live, at any time during their 
childhood from various symptoms which are characteristic 
of the third stage of the disease in the acquired form. 

Effect of Mercury 

Mercury preparations, if given steadily to a patient suf- 
fering from the first or second stage of syphilis, usually 
relieve all the symptoms in a very short time. The rash and 
the mucous patches soon disappear, the glands become 
smaller; until they, too, finally disappear. This curative 
action of mercury in syphilis is probably due to the de- 
struction of the spirochaeta pallida, the organism which 
causes the disease. 



504 MATERIA MEDICA 

Excretion 

Mercury preparations are excreted mainly by the kidneys 
and the intestines, and also slightly, by all the excretions, 
such as the saliva, niilk, bile, gastric juice, etc. They are 
very slowly eliminated from the body, usually in one or 
two days. Some of the mercury often remains in the body 
for a long time afterwards, and may then be gradually 
excreted for some time. 

Poisonous Effects 

Mercury poisoning occurs in two forms: acute poisoning 
and chronic poisoning. 

Acute Mercury Poisoning 

Acute mercury poisoning usually results from swallowing 
bichloride of mercury in tablet form or in solution either by 
accident or suicidal intent. Frequently the use of strong 
bichloride of mercury douches causes poisoning symptoms. 

Symptoms 

1. Metallic taste in the mouth, and burning pain in the 
throat. 

2. Cramp-like, abdominal pains. 

3. Nausea and vomiting; the vomited matter contains 
bile and later blood. 

4. Diarrhoea with bloody stools. 

5. Scanty urine which may contain albumin blood. 

6. Collapse, as a result of the profuse vomiting and 
diarrhoea; rapid, weak, irregular pulse, the face is pinched 
and anxious, the skin is cold and moist, the breathing slow 
and shallow. 

7. Comoilsions and coma may occur before death. 

Usually the patient lives several days or weeks; he de- 
velops a very severe acute nephritis characterized by scanty, 
bloody urine, which contains albumin. He finally develops 
uraemia with con\nilsions, coma and death. 

Death from mercury poisoning usually occurs in one to 
seven days. 



SPECIFICS 505 

If death does not occur recovery takes place very grad- 
ually, the symptoms of the nephritis persist and the patient 
develops salivation, soreness of the gums or gangrenous ulcers 
in the mouth, throat, jaws, palate or cheeks which last for 
a long time. 

When the poisoning results from vaginal douches the 
nausea and vomiting are absent, but the patient suffers 
principally from diarrhoea with serous or bloody stools which 
last for weeks, with soreness of the gums and ulceration of 
the jaw gradually developing. 

Treatment 

1. The antidote for mercury poisoning is white of egg, 
milk or flour. These substances contain albumins, which 
combine with the mercury, forming an albuminate of mer- 
cury, and thus prevent the poisonous effects. x4.bout one 
egg should be given for every 4 grains of bichloride of mer- 
cury or other preparation taken. 

2. Opium or morphine is given to check the diarrhoea, 
and to keep the patient quiet. 

3. The collapse is treated with heart stimulants such as 
caffeine, atropine, strychnine, etc. 

" Mercurialism " 

Mercurialism is a very common condition which results 
from prolonged use of mercury preparations. Syphilitic 
patients can often take large doses of mercury without 
developing any poisonous effects. 

Symptoms 

The following are the symptoms of excessive mercury 
action : 

1. Profuse flow of saliva, and a metallic taste in the mouth. 
This is soon followed by : 

2. Soreness and bleeding of the gums, later ulcerations of 
the gums, mouth or throat, loosening of the teeth, and even 
destruction of the jaw-bone. The breath has a very foul 
odor from the destroyed tissue. 



508 MATERIA MEDICA 

3. Diarrhoea, often with bloody stools, 

4. Anaemia. 

5. Loss of weight. 

6. Scanty urine. 

7. Paralysis of the hands or feet with ^^drop-wrists" or 
^^drop-feet." 

Treatment 

1. Stop the administration of mercury. 

2. The soreness of the gums is best relieved by a potassium 
chlorate mouth wash or a tannic acid mouth wash. The 
gums are often painted with tincture of myrrh. 

3. The diarrhoea is best checked by opium. 

Uses 

Mercury preparations are used principally : 

1. As a specific for the first and second stages of syphihs. 

2. Many of the preparations are excellent antiseptics. 

3. Some of the preparations are excellent purgatives. 

4. Mercury is said to have a very beneficial effect in re- 
lieving acute infections of the serous membranes, such as 
pleurisy or peritonitis. It also reduces enlargements of 
lymph glands. 

Administration 

1. For absorption from the skin, mercmy is applied by 
" rubbings " or inunctions in the form of an ointment. The 
ointment is thoroughly rubbed on the skin for six days, 
every day on a different region of the body; thus, one day 
on the arms, another day on the forearms, the thighs, the 
legs, the back, etc. On the seventh day the patient is 
given a bath to remove the ointment from the skin; and then 
the course is begun again. 

In giving mercury inunctions, the nurse should protect 
her hands with leather gloves, as otherwise she herself may 
£ibsorb the drug, and develop poisonous effects. 

Mercury is also given for absorption by the skin, in the 
form of vapor. The patient sits in a closed cabinet over a 



SPECIFICS 507 

lamp containing burning calomel. The fumes thus gener- 
ated are absorbed by the skin. Some mercury preparations 
are frequently given by mouth. 

An excellent method of giving mercury is by deep injec- 
tions into the muscles. The preparation is usually injected 
into the muscles of the buttocks, which are thus rubbed 
very thoroughly to hasten the absorption. 

Preparations 

Bichloride of Mercury 0.0012-0.006 gm. gr. ^-^-^ 

Corrosive Sublimate 

(Hydrargyri Chloridum Corrosivum) 

This is raiely used internally. It is principally used as 
a local antiseptic in 1-1000 to 1-5000 solutions. It usually 
comes in tablets of 0.5 gm. (grs. viij) each, which are dis- 
solved in water to make up the required strength. Corrosive 
sublimate cannot be used to disinfect instruments, as it 
stains them black. 

Mild Mercurous Chloride 0.006-0.3 gm. gr. -^^-v 

Calomel 

(Hydrargyri Chloridum Mite) 

This preparation is used principally as a cathartic. It is 
given in tablets or as a dry powder on the tongue. 

Blue Mass 0.1-0.5 gm. grs. ii-viii 

(Massa Hydrargyri) 

This is mercury rubbed with glycerin, honey, licorice, 
althaea, etc., and contains 33|% of mercury. It is used 
principally as a cathartic, in the form of pills; each pill con- 
taining 0.2-0.3 gm. (grs. iii-v) of blue mass. 

Mercury with Chalk 0.12-0.5 gm. grs. ii-viii 

Gray Powder 
(Hydrargyrum cum Creta) 

This is a gray powder made Hke blue mass, but it con- 
tains chalk :i}. addition to the other ingredients. It is used 
as a mild cathartic. 



508 MATERIA MEDICA 

i'ellow Iodide of Mercury 0.008-0.06 gm. gr. |-i 

Protoiodide of Mercury 
(Hydrargyri lodidum Flavum) 

Red Iodide of Mercury 0.0012-0.006 gm. gr. ^Vt'o 

Biniodide of Mercury 
(Hydrargyri lodidum Rubrum) 

Solution of Arsenic and Mercuric 
Iodides 0.06-0.3 c.c. m. i-v 

(Liquor Arseni et Hydrargyri lodidi) 
(Donovan's Solution) 

This contains 1% each of arsenic iodide and the red mer- 
curic iodide. 

For Local Use 
Mercurial Ointment 
Blue Ointment 
(Unguentum Hydrargyri) 

This is made by thoroughly rubbing together mercury, 
oleate of mercury, lard and suet. It is used principally for 
inunctions. 

Ointment of Yellow Mercuric Oxide 
(Unguentum Hydrargyri Oxidi Flavi) 

This contains 10% of yellow oxide of mercury. 

Ointment of Red Mercturic Oxide 
(Unguentum Hydrargyri Oxidi Rubri) 

This contains 10% of red oxide of mercury. 

Ointment of Ammoniated Mercury 
(Unguentum Hydrargyri Ammoniati) 
This contains 10% of ammoniated mercury. 

Ointment of Mercuric Nitrate 
(Unguentum Hydrargyri Nitratis) 
Citrine Ointment 
This contains 7% of mercuric nitrate. 

New and Non-official Preparaticsit: 
Black Wash 
(Lotio Hydrargyri Nigra) 



SPECIFICS 509 

This consists of 4.0 gms. (5 i) of calomel to 500 c.c. (1 pt.) 
of lime water. It is used principally as an external appli- 
cation. 

Yellow Wash 

(Lotio Hydrargyri Flava) 

This consists of corrosive sublimate 2.0 gms. (5 1) to 
500 c.c. (1 pt.) of lime water. It is used principally as a 
local application. 

Mercuric Salicylate 0.003-0.008 gm. gr. ^W 

(Hydrargyri Salicylas) 

This preparation is now frequently used, especially for 
intramuscular injections. For these injections, a 10% solu- 
tion in water or liquid paraffin is used, of which 0.6 c.c. (m. x) 
is injected deep into the gluteal muscles every fourth day. 

Mercuric Succinimide 0.01-0.015 gm. gr. |-|^ 

(Hydrargyri Succinimidum) 

This is used principally for intramuscular injections. A 
2^% solution is used, of which 0.5-1.0 c.c. (m. viii-xv) are 
injected daily. 

It also comes in hypodermic tablets, each containing 
0.006-0.003 (gr. ^-^). 

Mercurol 0.03-0.12 gm. grs. ^-ii 

(Hydrargyri Nucleinas) 

This is said to have a special value as an antiseptic and 
specific for syphilis. 

Mergal one capsule 0.015 gm. gr. ^ 

This is a mixture of mercuric cholate and albumin tannate 
put up in capsules. Each capsule contains 0.05 gm. (gr. |) 
of mercuric cholate. 



3 



Mercuric Benzoate 0.015-0.03 gm. gr. f 

(Hydrargyri Benzoas) 

This has been used principally as a specific for syphilis 
and is given hypodermic ally. 



510 MATERIA MEDICA 

Calomelol 

Colloidal Calomel 

(Hydrargyri Chloridum Mite CoUoidale) 

Calomelol is a preparation of calomel combined with al- 
buminoids, and is said to act more efficiently, not to gripe 
as much, and to be less poisonous than calomel. 

THE IODIDES 

The iodides are salts formed by the action of an alkaU, 
such as sodium, potassium or ammonium, on hydriodic 
acid, an acid formed from iodine; which is a non-metallic 
element, obtained from sea-weeds. 

Appearance of the Patient 

After a single dose of one of the iodide salts is given, ex- 
cept for its slightly metallic salty taste, a slight burning 
pain in the stomach, and perhaps some slight nausea for a 
few minutes, there are no appreciable effects. 

If the iodides are given continuously for some time, how- 
ever, the secretions are all increased, the pulse is somewhat 
faster and softer, the patient passes more urine and feels 
much better. 

Prolonged administration of the iodides to a patient suf- 
fering from any manifestation of syphilis, especially any 
symptoms of the third stage, causes a gradual disappearance 
of these symptoms, and in a very short time the patient 
feels entirely well again. For example, if the patient has a 
syphilitic ulcer in any region of the body, the ulcer gradually 
heals. A syphilitic paralysis when treated with an iodide 
preparation, soon disappears, and the patient can move the 
paralyzed extremity perfectly well again. 

ACTION 
Local action. The iodides produce no local effect when 
applied on the skin or mucous membranes, but they are 
rapidly absorbed into the blood from ail mucous membranes. 

Internal Action 
In the mouth: The iodides have a characteristic salty 
metallic taste. 



SPECIFICS 511 

In the stomach: They slightly increase the secretions, 
and occasionally cause nausea, and slight discomfort. The 
intestines are not usually affected by the iodides. 

Action after Absorption 

The iodides are very rapidly absorbed into the blood; from 
the stomach, intestines, and from all the mucous membranes 
usually in about five minutes. After absorption, they act 
principally as a specific for syphilis. They also affect the 
secretions, the thyroid gland, newly formed tissues, the nutri- 
tion, and slightly the kidneys. 

Specific Action in Syphilis 

The most striking effect of the iodides is noticed in pa- 
tients suffering from syphilis, especially from the symp- 
toms of the third stage. These symptoms are the result 
of the formation of areas of round cells (gummata) in 
various parts of the body as a result of the presence in the 
blood of the spirochaeta pallida. These newly formed areas 
of cells very soon become fluid and areas of various tissues 
and organs of the body are thus destroyed, producing various 
symptoms. 

Very soon after the treatment with the iodides is begun 
in such cases, the patient feels better, the particular mani- 
festation of syphilis from which he uisiy be suffering, begins 
to improve, until finally he is entirely well again. For 
example, if the patient is suffering from a syphilitic ulcer 
in any part of the body, this ulcer heals very rapidly after 
treatment with iodides. 

A syphilitic paralysis due to the formation of a gumma in 
the brain or spinal cord, when treated with iodides soon dis- 
appears. The affected extremities regain their motion and 
the patient soon feels entirely well again. In a similar man- 
ner, a syphilitic condition of any organ of the body is cured. 

The iodides cure the third stage of syphilis, by causing 
the absorption of newly formed areas of round cells, or 
gummata, which cause the various symptoms. They also 
probably destroy the spirochaetae which cause the disease. 



512 MATERIA MEDICA 

Action on the secretions: The iodides increase the secre- 
tions of all the mucous membranes and the secretory glands. 
The mucus from the nose and bronchi is increased, and 
becomes more fluid in character. The secretion of saliva, 
of milk, and the secretions of the other glands are also slightly 
increased. 

Action on the Thyroid Gland: Iodine is a normal constit- 
uent of the thyroid gland and is necessary for the formation 
of its secretion. By providing this gland with more iodine 
its secretions are increased. As a result, it makes the pulse 
somewhat more rapid, and lowers the blood pressure. The 
absorption of newly formed connective tissue cells may also 
be due to the action on the thyroid gland. These cells be- 
come more fluid in character and are more readily absorbed. 

Action on nutrition: They increase the nutrition of the 
tissues and hasten the excretion of waste products. It is 
probably due to the increased secretion of the thyroid gland. 

Effect on newly formed connective tissues: The iodides 
increase the absorption of newly formed connective tissue. 
They are used to absorb old scar tissue in any organ of 
the body. They are frequently used for this effect in 
arteriosclerosis (hardening of the arteries), cirrhosis of the 
liver, etc. 

Newly formed connective tissue cells are small round cells 
which resemble the round cells found in gunamata. These 
cells may therefore be affected by the iodides in the same 
way as the gunmiata or round cell formations of the third 
stage of syphihs or as a result of the increased secretion of 
the thyroid gland. 

Accumulations of serum in the chest (pleurisy with ef- 
fusion) or in other parts of the body, are more rapidly ab- 
sorbed when iodides are given. 

Action on the circulation: Iodides do not usually affect 
the pulse. They occasionally lower the blood pressure when 
it is high and make the pulse somewhat more fapid. The 
effect is probably due to the increase in the secretion of the 
thyroid gland. 

Action on the kidneys: The iodides slightly increase th© 
flow of urine. 



SPECIFICS 513 

Excretion 

The iodides are eliminated from the body by the urine, 
mainly as iodides, usually within twenty-four hours. In the 
body the iodine is separated from the iodide salts, which is 
then excreted in all the secretions of the secretory glands 
and mucous membranes. The mucus of the nose and the 
bronchi, the saliva, the milk, the hair, all contain iodine. 

Idiosyncrasies 
In some individuals small doses of the iodides often 
cause poisonous effects. 

Poisonous Effects 

The iodides do not cause acute poisoning. Since they are 
excreted more slowly than they are absorbed, after pro- 
longed administration, chronic poisoning or iodism fre- 
quently results from the accumulation of some of the drug 
in the body. These cumulative symptoms occasionally oc- 
cur in some individuals from very small doses. 

The symptoms of iodism are due to the excretion of the 
iodine by the various mucous membranes, and they are not 
so apt to occur in syphilitic patients. 

Cumulative Symptoms or " Iodism " 

The first symptom of excessive iodide action is: 
Profuse secretion of mucus from the nose (coryza) and 
sneezing. 

These are soon followed by: 

2. Red, swollen eyelids with excessive flow of tears. 

3. Frontal headache. 

4. Cough, with profuse expectoration of mucus. 

5. Increased flow of saliva. 

6. Sore throat and difficulty in swallowing. 

7. Skin eruptions, such as areas of redness, or small 
pustules on the face, back, shoulders or thigh (acne). Oc- 
casionally eczema occurs. 

8. The pulse is often rapid and a slight rise in temperature 
may occur. 

9. Nausea and diarrhoea occasionally occur. 



514 MATERIA MEDICA 

10. Weakness, loss of weight, and pains in the joints oc- 
casionally result from continued use. 

Treatment 

When the iodides are stopped, the symptoms usually 
disappear. 

Uses 

The iodides are used principally : 

As. a specific for the third stage of syphilis. In syphilis, 
the treatment must be continued for about three years; 
even if the patient has no symptoms, to eradicate all the 
poison from the body. 

2. They are also frequently used to absorb connective 
tissue in various chronic diseases . characterized by the for- 
mation of connective tissue in various organs and tissues of 
the body. For example, in arteriosclerosis (thickening of 
the blood vessels by the formation of connective tissue in 
their walls), cirrhosis of the liver, or the formation of con- 
nective tissue in the liver, chronic nephritis or the forma- 
tion of connective tissue in the kidneys, etc. 

3. To increase the absorption of inflammatory swellings 
of the glands and other tissues, and to absorb fluids in the 
chest. 

4. To increase the secretions of the mucous membranes, 
such as those of the bronchi, the nose, etc. 

Administration 

The iodides are best given after meals, in milk, wine, 
aromatic spirits of ammonia, or the compound spirits of 
sarsaparilla, or cinnamon water, to disguise the unpleasant 
taste. It is occasionally given in pills or capsules. 

Preparations 

Potassium Iodide 0.3-LO gm. grs. v-xv 

(Potassii lodidum) In syphilis it may be given up to 4.0 gms. (si) 

This is the most efficient and most commonly used prepa- 
ration. It often comes in 50% or saturated (100%) solutions. 



SPECIFICS 515 

Sodium Iodide 0.12-1.3 grn. grs. ii-xx 

(Sodii lodidum) 

Ammonium Iodide 0.12-1.0 gm. grs. ii-xv 

(Ammonii lodidum) 

Strontium Iodide 0.3-1.0 gm. grs. v-xv 

(Strontii lodidum) 

Dilute Hydriodic Acid 0.3-0.6 c.c. m. v-x 

(Acidum Hydriodicum Dilutum) 

This contains 10% of hydriodic acid. 
Syrup of Hydriodic Acid 2.0-8.0 c.c. S^-ii 

(Syrupus Acidi Hydriodici) 

This contains 1% of hydriodic acid. 

For Local Use 
Potassium Iodide Ointment 
(Unguentum Potassii lodidi) 

New and Non-official Preparations 
Sajodin 1.0-3.0 gms. grs. xv-xlv 

This acts like potassium iodide; but is said not to produce 
the symptoms of iodism. 

Ferro Sajodin 1-2 tablets 

This contains 5% of iron and 24% of iodine. It comes in 
tablets, each containing 0.5 gm. (grs. viii) of ferro sajodin. 

lodo Casein 0.3-1.3 gm. grs. v-xx 

It is digested in the intestine where it is rapidly absorbed, 
then acting like the iodides. It does not disturb digestion 
as much as the other iodides. 

lodalbin 0.3-0.6 gm. grs. v-x 

This is a compound of iodine and albumin from blood. 
It is absorbed from the intestines, and it then acts like the 
other iodides. 
lodipin 0.2-0.6 gm. grs. iii-x 

This is a compound of iodine and sesame oil. It acts like 
the other iodides, but its effects are more lasting, and they 



516 MATERIA MEDICA 

are said not to cause iodism. It is given hypodermically. 
It usually comes in 10 or 25% solutions or in capsules, each 
containing 2.0 gms. (grs. xxx). 

lothion 

This acts like the iodides or iodine, and is readily ab- 
sorbed from the skin. It is applied in a 25 to 50% ointment 
like mercury ointment. 

SALVARSAN OR ARSPHENAMINE 

Salvarsan, arsphenamine, arsenobenzol, or " 606 " is a 
complex organic arsenic salt. It is a yellow powder which 
comes in a sealed glass tube together with nitrogen gas, 
since it is readily changed by the oxygen of the air. 

ACTION 

Salvarsan is a specific for all stages of syphilis. It com- 
bines with, and destroys the Spirochaeta pallida, the organ- 
ism which causes the disease. In a few weeks after the ad- 
ministration of the remedy, there is a remarkable and prompt 
disappearance of all the symptoms of the disease, such as 
the initial sore, the rash, the mucous patches and the other 
manifestations. The patient is not considered cured, how- 
ever, until the examination of his blood shows that he is 
free from the disease. The administration of the remedy 
is therefore repeated at weekly intervals. 

The symptoms of the third stage of syphilis frequently re- 
turn as long as twenty years after the original infection and 
since salvarsan has only been in use for a few years, it is im- 
possible to state at the present time whether the cure is 
permanent or not. Salvarsan should therefore be used in 
conjunction with, or followed by, the usual two year course 
of treatment with merciuy and iodides. 

Salvarsan has also been usbd wiih success in the treatmen t 
of malaria and other infectious diseases resulting from the 
circulation in the blood of parasitic organisms, such as those 
of relapsing fever, frambesia, etc. 

Neosalvarsan is not as efficient as salvarsan, therefore it 
must be given in larger doses, but it is easier to administer. 



SPECIFICS 517 

Idiosyncrasies 

1. Symptoms of arsenic poisoning may result. 

2. The rash may temporarily become more intense, there 
may be a rise in temperature, headache and ringing in the 
ears (Hexheimer's reaction). 

Administration 

Salvarsan is usually given by direct injection into the veins. 

The ampoule containing the salvarsan is wiped off with 
alcohol and the neck is filed and broken off. The powder is 
then put into a sterile glass stoppered bottle. Sterile dis- 
tilled water is now added and the powder is dissolved by 
shaking the bottle. A 15% Sodium hydroxide solution is 
then added drop by drop, until the fluid becomes cloudy. 
A few drops more are added and the cloudiness clears up. 
It is usually necessary to add about 3 or 4 drops of the 
Sodium hydroxide solution for every 0.1 gm. of salvarsan. 
The mixture is then diluted by adding about 30 c.c. of 
sterile water for each 0.1 gm. of salvarsan used. The sal- 
varsan solution is now ready for administration and it is 
poured into a glass apparatus and allowed to run into the 
vein very slowly through a rubber tube and intravenous 
needle. Some physicians dissolve the salvarsan in much 
smaller quantities of fluid. It is also given by deep injec- 
tions into the muscles. 

2. Neosalvarsan is dissolved in sterile, distilled water, 
about 25 c.c. being used for every 0.1 gm. of the drug. 

It is given like salvarsan, by injection into the veins 
(intravenously), or into the muscles (intramuscularly). 

Neosalvarsan is only half as strong as salvarsan. It does 
not have to be neutralized with an alkali. 

Swift Ellis Method 

This method consists of injecting into the spinal canal, the 
serum of the patient after salvarsan has been injected into 
the veins. Such prepared serum is given in cases of syphilis 
of the brain and spinal cord. A dose of salvarsan is injected 
into the vein and an hour later 40 c.c. of blood is withdrawn 



518 MATERIA MEDICA 

from the vein. This is allowed to clot and is then placed on 
ice for twenty-four hours. ^^Tien the blood has clotted en- 
tirely the serum is removed with a pipette. A 40% solu- 
tion is then made of this serum by adding 12 c.c. of the 
serum to 18 c.c. of normal salt solution. The solution is 
now heated for about half an hour to a temperature of about 
50° C. and is then injected into the spinal canal after re- 
moving the same quantity of fluid from the spinal canal. 

Preparations 

Arsphenamine or Salvarsan 0.3-0.6 gm. grs. v-x 

Arsphenolamine hydrochloride 
*' 606 " 

This contains about 31% of arsenic. 

Neolsalvarsan 0.6-0.9 gm. grs. x-xiv 

Salvarsan is now made by different firms under the fol- 
lowing names : 

Arsaminol 

Arsenobenzol 

Diarsenol 

Neoarsphenamine 

Arsphenolamine S (Neosalvarsan) 

SALICYLIC ACID AND THE SALICYLATES 

Salicylic acid is a white crystalline powder which is made 
chemically by the action of sodium hydroxide (caustic soda) 
and carbonic acid, on carbolic acid. 

The salicylates are salts formed by the combination of an 
alkali, with salicylic acid. For example, sodium salicylate 
is formed when salicylic acid is combined with sodium. 
Various other salts are made in a similar way, by the com- 
bination of an organic chemical substance, such as methyl 
alcohol, with salicyhc acid. Methyl salicylate is formed in 
this way. 

Many salicylates are found in various plants. For 
example, methyl salicylate is found in the oil of wintergreen, 
or oleum gaultheriae, and in the oil of sweet birch, oleum 
betulae. 



SPECIFICS 519 

There are many new artificial preparations made chemi- 
cally from salicylic acid or its salts, some of which, such 
as aspirin, are extensively used. 

Appearance of the Patient 

About 15 minutes after an average dose of salicylic acid, 
or one of the salicylates is given, the patient complains of a 
shght burning pain in the pit of the stomach, and possibly of 
a slight feeling of fullness in the head. Soon he sweats pro- 
fusely, and the temperature is lowered 1 or 2 degrees, par- 
ticularly if there is fever. The pulse may be somewhat faster 
and stronger, unless a large dose has been given, when 
it may be slightly slower and weaker. The breathing is 
usually somewhat more rapid, and the patient passes more 
urine. 

If the patient is suffering from acute articular rheumatism, 
the pains and swellings around the joints are gradually 
relieved. 

ACTION 

Local action: Sahcylic acid and the salicylates are anti- 
septics. They also soften the epidermis or hard layer of the 
skin when directly applied. On mucous membranes, they 
cause redness and increased secretions (irritation). 

Internal Action 

In the mouth : They have a pecuhar salty sour taste. 

In the stomach : Salicyhc acid and the salicylates increase 
the secretions. If given when the stomach is empty, they are 
apt to cause burning pain in the stomach, occasionally nau- 
sea, and possibly vomiting. 

In the intestines : They have an antiseptic action, checking 
the growth of bacteria. 

Action after Absorption 

Sahcylic acid and the salicylates are rapidly absorbed from 
the stomach and intestines, usually in about 15 minutes. 
After absorption, they affect the temperature, the sweat 



520 MATERIA MEDICA 

glands, the circulation, the respiration and the kidneys. 
They affect especially acute articular rheumatism. 

Specific Action in Rheumatism 

Salicylic acid and the salicylates are used principally as 
specifics for acute articular rheumatism. 

Acute articular rheumatism is a disease characterized by 
pain, redness and swelling of the various joints of the body, 
associated with high temperature. The disease begins in 
one joint, and then affects many of the others. Its cause 
is unknown, though it is probably an infectious disease. 

Effect of Salicylates 

When any of the salicylates are given regularly for some 
time, to a patient suffering from acute articular rheumatism, 
the pains become lessened in a few days, the redness and 
swelling of the joints are diminished, the temperature sub- 
sides, and the patient soon gets well. 

The mode of action is probably due to the excretion of 
salicylic acid into the joints and thus affecting the causative 
agent of the disease. Many cases are improved by some 
preparations of the salicylates more than by others. Other 
cases are not improved at all by any of them. Chronic rheu- 
matism does not respond so readily to treatment with the 
salicylates. 

Effect on temperature : The salicylates reduce the tempera- 
ture several degrees in fevers, because of the increased elimi- 
nation of heat which results from the profuse sweating and 
dilated blood vessels of the skin. The temperature begins 
to go down in fifteen minutes, and stays down for about 
six hours. The normal temperature is not affected, however. 

Action on the secretions: The salicylates increase the se- 
cretion of sweat especially. About fifteen minutes to a half 
hour after a dose of one of the salicylates is given, the patient 
is usually covered with profuse perspiration. The sahcylates 
are said to also increase the flow of bile. 

Action on the circulation : The salicylates usually make the 
pulse somewhat faster and stronger at first, by increasing 



SPECIFICS 521 

the contractions of the heart muscle and contracting the 
blood vessels. 

With larger doses, the contractions of the heart muscle are 
soon weakened and the pulse becomes slower and weaker. 

The blood vessels of the skin are usually dilated, so that 
the skin is flushed. 

Action on the respiration : The breathing becomes slightly 
more rapid; occasionally the patient is somewhat short of 
breath (dyspnoeic). 

Action on the kidneys: The salicylates increase the se- 
cretion of urine. They act as antiseptics along the urinary 
organs, and make the urine more acid in reaction; due to in- 
creasing the amount of uric acid. The urine occasionally 
contains albumin. 

Excretion 

The salicylates are eliminated from the body as salicyluric 
acid, mainly by the urine; usually in several hours. Some of 
the drug is also excreted in the perspiration, milk and bile. 

Poisonous Effects 

Large doses of salicylates often cause quite alarming 
symptoms, especially if used for a long time, but they are 
rarely fatal. The symptoms resemble those of quinine 
poisoning. 

Symptoms 

Overdoses of salicylates cause the following sjnnptoms : 

1. Buzzing and noises in the ears, and a feeling of fullness 
in the head. 

2. Deafness. 

3. Dimness of vision. 

4. Profuse perspiration. 

5. Feehng of warmth all over the body. 

6. Occasionally nausea and vomiting. 

In severe cases besides these symptoms there are usually: 

7. Dyspnoea, rapid, irregular, deep and labored breathing. 

8. Collapse (slow, weak pulse, subnormal temperature, 
cold, moist skin, etc.). 

9. Unconsciousness. 



522 MATERIA MEDICA 

10. Occasionally the patient becomes delirious or even 
maniacal, and he often seems to see various objects about 
him (hallucinations of sight) or he seems to hear voices (hal- 
lucinations of hearing) . 

Death has rarely resulted from salicylate poisoning. 

Treatment 

1. If the drug is stopped, the symptoms usually disappear 
in a few days or a week. 

2. Caffeine, strychnine, or other heart stimulants are 
usually given, if the pulse is weak. 

Administration 

Salicylic acid or the sahcylates, are best given in capsules, 
tablets or in a small quantity of milk or syrup, about an hour 
or two after meals. 

They are best given with sodium bicarbonate to overcome 
the pain in the stomach, or the nausea and vomiting which 
may result from the rapid formation of salicylic acid in the 
stomach. 

Preparations 
Salicylic Acid 0.3-2.0 gms. grs. v-xxx 

(Acidum Salicylicum) 

This is more readily dissolved in hot water or in a solution 
of boric acid or borax. 

Sodium Salicylate 0.3-2.0 gms. grs. v-xxx 

(Sodii Salicylas) 

This is more soluble than the salicylic acid and is not so 
apt to upset the stomach. 

Lithium Salicylate 0.3-2.0 gms. grs. v-xxx 

(Lithii Salicylas) 

Ammonium Salicylate 0.3- gm. grs. v 

(Ammonii Salicylas) 

Strontium Salicylate 1.0- gm. grs. xv 

(Strontii Salicylas) 

Oil of Wintergreen 0.3-1.0 c.c. m. v-xv 

(Oleum Gaultheriae) 



SPECIFICS 523 

This is a volatile oil obtained by distilling Gaultheria 
procumbens or wintergreen. It contains 90% of methyl 
salicylate and is given in an emulsion or in capsules. It acts 
like the salicylates, but ii) occasionally causes nausea and 
vomiting. 

Oil of Sweet Birch 0.3-1.0 c.e. m. v-xv 

(Oleum Betulae) 

This is made by distilling the bark of Betula lenta or 
birch bark. 

Methyl Salicylate 0.3-1.0 gm. grs. v-xv 

(Methylis Salicylas) 

This is artificial oil of wintergreen. It is contained in oil 
of wintergreen and oil of sweet birch. 

Salicin 0.3-2.0 gms. grs. v-xxx 

(Salicinum) 

Salicin is a glucoside obtained from the bark of various 
species of willow and poplar trees. It is changed to salicylic 
acid in the body and it then produces the same effects. 

It has a very bitter taste and is not as reliable in its action 
as the other preparations. 

Salol 0.3-2.0 gms. grs. v-xxx 

(Phenylis Salicylas) 

Salol is a tasteless powder which is decomposed by the 
steapsin of the pancreatic juice in the intestine, into salicylic 
and carbolic acids. The salicylic acid is absorbed into the 
blood from the intestines, and it then produces the same 
effects as the salicylates. It is frequently used as an intestinal 
and urinary antiseptic. Symptoms of carbolic acid poison- 
ing occasionally result from the carboHc acid which is 
formed in the intestines. 

For Local Use 
•^Borosal'^ Solution 

(Thiersch Solution) 

This is a solution made by dissolving a Thiersch powder 
in 1000 c.c. or a quart of water. 
Each Thiersch powder contains: 



524 MATERIA MEDICA 

Boric Acid 15.0-30.0 gms. 5H 

Salicylic Acid 2.0- 4.0 gms. SH 

Thiersch solution is used as an antiseptic dressing, and is 
particularly valuable to soften the skin. 

Salicylic Acid Ointments: 

These usually contain from 2 to 20% of salicylic acid and 
are principally used to soften and remove corns. Many 
corn salves and plasters consist principally of salicylic acid. 

New and Non-official Preparations 

Aspirin 0.3-1.0 gm. grs. v-xv 

(Acidum Acetylsalicylicum) 

This is a compound made chemically from salicylic acid. 
It is absorbed in the intestines and then acts like salicylic 
acid, but because it is very slowly absorbed, its effects are 
more lasting. It is not so apt to cause poisonous effects. 

Novaspirin 0.3-1.0 gm. grs. v-xv 

(Methylene Citrylsalicylic Acid) 

It acts like aspirin but is said not to upset the stomach, 

Diaspirin 1.0 gm. grs. xv 

Succinyl Disalicylic Acid 

Ethyl Salicylate ^ 0.3-0.6 c.c. m. v-x 

(Aethylis Salicylas) 

(Sal Ethyl) 

This is similar to methyl salicylate, and is said not to cause 
poisonous symptoms. 

Mesotan or Ericin 

This is an oily fluid made from sahcylic acid (methyl 
oxymethyl sahcylate). It acts hke the oil of wintergreen 
and is applied to the skin in an equal part of olive oil. 

Salophen 0.3-1.0 gm. grs. v-xv 

This resembles salol in its action. It is changed in the in- 
testines to salicylic acid, and acetylparamidophenol, which is 
not poisonous. It is therefore safer than salol. 

Saloquinine 0.5-2.0 gms. grs. viii-xxx 



These are preparations whicli act like salol. 



SPECIFICS 525 

This is a compound of quinine and salicylic acid; quinine 
salicylate. It combines the action of both. 

Saloquinine Salicylate 1.0 gm. grs. xv 

This acts like saloquinine. 

Spirosal 

Monoglycol Salicylate 

This is absorbed from the skin and acts like salicylic 
acid which it forms in the body. It is applied on the skin 
in solutions. The drug is dissolved in three parts of alco- 
hol or in eight parts of olive oil. 
Betol or Naphthol 
Naphtholis Salicylas 

Cresol (official) 
Thymosalol 

Antipyrine salicylate, PhenocoU salicylate, Saliphen, Mala- 
kine, are all used mostly to reduce fever, though they also act 
like salicyhc acid which they form in the body. (See analgesic 
antipyretics.) 

COLCHICUM (MEADOW SAFFRON) 

Colchicum is obtained from the seeds, Colchici semen and 
underground stems, Colchici cormus, of the meadow saffron 
or Colchicum autumnale, a small plant growing in Europe 
and England, The active principle is a substance called 
colchicine. 

Appearance of the Patient 

An ordinary dose of colchicum causes very little effect, 
but several hours after a moderate dose is given, the patient 
complains of some abdominal pain, perhaps of a Httle nausea, 
and later he has frequent movements of the bowels and the 
urine may be somewhat increased. The pulse may be a 
little slower and occasionally the tears, saliva and sweat are 
somewhat increased. 

If the patient is suffering from an attack of acute gout, 
the severe pains of this condition are usually relieved. 

ACTION 
Local action: Applied to the skin or mucous membranes, 
it acts as an irritant. 



526 MATERIA MEDICA 

When given internally it irritates the mucous membrane 
of the stomach, causing nausea and vomiting. 

It is slowly absorbed from the stomach. After absorption 
it principally affects acute gout. It also increases the secre- 
tion of urine. Large doses make the pulse and breathing 
somewhat slower. 

Action in Gout 

Acute gout is a disease characterized by severe pain, red- 
ness and swelling of one or more joints of the body. The 
joints of the toes and hands are particularly affected, and 
the pains more often occur at night. The disease is said to 
be due to the deposit in the joints, of crystals of uric acid, 
which is ordinarily a fluid constituent of the urine. 

Colchicum relieves particularly the pains of acute gout, 
though it is not really a specific for that disease. 

Poisonous Effects 

Colchicum is a very violent poison, small doses having 
caused death. An overdose of colchicum usually causes the 
following symptoms within a few hours : 

1. Severe abdominal pain. 

2. Nausea, and continual profuse vomiting, which is ac- 
companied by profuse secretion of saliva, tears and mucus 
from the nose. 

3. Profuse diarrhoea, often with bloody stools. 

4. Scanty and bloody urine, or there may be no urine 
secreted at all. Occasionally the urine may be increased. 

5. Spasms of the muscles, even convulsions, followed by 
great muscular weakness, with slow movements and paraly- 
sis. 

6. Collapse (rapid, thready pulse, slow and shallow breath- 
ing, cold moist skin). 

Death soon results from respiratory paralysis. 

Treatment 

1. Give tannic acid preparations, to neutralize the col^ 
chicum. 

2. Wash out the stomach. 



SPECIFICS 527 

3. Protect the mucous membrane by white of egg, milk, 
etc. (demulcents). 

4. Keep the patient quiet. 

5. The collapse is treated with stimulants, such as caf- 
feine, strychnine, etc. 

Preparations 

Colchicum Stems 
Extract of Colchicum Stems 0.03-0.12 gm. grs. J-ii 
(Extractum Colchici Cormi) 

Colchicum Seeds 

The preparations of the seeds are principally used. 

Wine of Colchicum Seeds 0.6^.0 c.c. m. x-5i 

(Vinum Colchici Seminis) 

This contains 10% of colchicum and is the preparation 
conunonly used. 

Fluidextract of Colchicum Seeds 0.1-0.3 c.c. m. ii-v 
(Fluidextractum Colchici Seminis) 

Tincture of Colchicum Seeds 0.3-1.0 c.c. m. v-xv 

(Tinctura Colchici Seminis) 

Colchicine (the active principle) 0.0005 gm. gr. ixcr 

PIPERAZINE (not official) 

Piperazine is a chemical substance which is frequently 
used to relieve gout, and to dissolve stones in the kidney 
and bladder. Its use is based upon the fact that it dissolves 
uric acid crystals, when added to them in a test tube. Prac- 
tical experience in the use of this drug has not borne out this 
effect on the patient. It slightly increases the flow of urine, 
however. 

Preparations 

Piperazine 0.3-0.6 gm. grs. v-x 

(Piperazina) 

Lycetol 1.0-2.0 gms. grs. xv-xxx 

Dimethyl Piperazine Tartarate 

Sidonal or Piperazine Quinnate 1.0-1.3 gm. grs. xv-xx 

(Piperazinae Quinnas) 



528 MATERIA MEDICA 



ATOPHAN OR CINCHOPHEN 

Atophan, cinchophen, or phenylcinchoninic acid, is a white, 
crystalline substance which is made chemically from various 
other complex substances. 



ACTION 

Atophan has a specific action in acute gout. It relieves the 
pains around the joints very promptly. It increases the secre- 
tion of urine and the amount of uric acid contained in it. 
Beneficial effects have also been obtained from its use in 
other chronic joint affections, such as rheumatism, etc. 

It is not a poisonous drug, and is therefore safer than col- 
chicum. 

Preparations 

Atophan or Cinchophen 0.3-1.0 gm. 

Phenylcinchoninic Acid 

Novatophan 0.3-1.0 gm. 

Paratophan 0.3-1.0 gm. 

CIMICIFUGA (BLACK SNAKEROOT) 

Cimicifuga is obtained from the roots and underground 
stems of the Cimicifuga racemosa, an American plant which 
grows abundantly in shady woods. 

It is used as a bitter, to relieve gout and rheumatism, and 
occasionally to relieve nervousness. 

Preparations 

Extract of Cimicifuga 0.3-1.0 gm. grs. v-xv 

(Extractum Cimicifugae) 

Fluidextract of Cimicifuga 1.0-4.0 gms. m. xv-3i 

(Fluidextractum Cimicifugae) 

Tincture of Cimicifuga 4.0-8.0 c.c. 3i-ii 

(Tinctura Cimicifugae) 



grs. 


v-xv 


grs. 


v-xv 


grs. 


v-xv 



SPECIFICS 529 

EMETINE 

Emetine is a white powder, the active alkaloid of ipecac. 
It was formerly used only to produce vomiting. Locally 
it is an antiseptic. It is especially destructive to amoebae, 
which are unicellular organisms many species of which 
cause disease particularly in the large intestine. Even a 
solution of 1 to 1,000,000 destroys amoebae. 

Applied to the skin emetine is very irritating and may 
cause pustules if applied long enough. 

When given by mouth or hypodermically in large doses 
it causes nausea and vomiting. On account of its destructive 
action on amoebae it is principally used as a specific in 
amoebic dysentery, a form of dysentery caused by a species 
of amoebae. 

Emetine has also been used extensively in the treatment 
of pyorrhoea alveolaris, an infected condition of the teeth 
sockets. Amoebae are found in the pus of this disease, but 
they are evidently not the cause of it. Emetine is beneficial 
in this disease but it does not cure it. 

Emetine has also been used to check haemorrhage from 
the lung (haemoptysis). 

Poisonous Effects 

The poisonous effects that result from emetine are ab- 
dominal pain, pain on passing stool and delirium. 

Emetine Hydrochloride 0.01-0.02 gm. gr. i-i 

It is usually given by hypodermic injection. In pyorrhoea 
alveolaris it is also applied locally to the gums. 

RADIUM 

Radium is a chemical element obtained from Hungary. 
The salt commonly used in medicine is radium bromide. 
This usually comes in sealed glass tubes enclosed in gold, 
silver or platinum. Radium differs from other chemical 
substances in a very singular way. It is constantly giving off 
atoms in the form of invisible rays which are capable of pro- 
ducing energy and destroying tissue. Substances which 



530 MATERIA MEDICA 

have this property are said to be radio active. The constant 
loss of the atoms takes place so slo^Yly that the action of the 
radium is not materially lessened by constant use. In 
fact, it is claimed that radium will retain its activity for 
about 2500 years. 

The active rays of radium are able to destroy tissues and 
are of three kinds: alpha, beta and gamma rays. The 
gamma rays are the most penetrating and are able to 
reach deep tissues, while the alpha and beta rays affect only 
the superficial cells. The alpha rays may be screened off by 
interposing a piece of paper between the radium and the 
tissue to be affected, and the beta rays by a thin piece of 
lead. 

ACTION 

Radium acts only locally, on direct application to the 
tissue to be treated. If a tube of radium is applied for some 
time on the normal skin, it will produce a red and tender 
area with the formation of a scab. A longer application, 
or a stronger tube, will form an ulcer which heals readily, 
however. 

When applied for some time to a cancer, radium destroys 
some of the cancer cells, checks its growth and relieves the 
pain. 

Uses and Administration 

Radium is used principally in the treatment of cancer and 
rodent ulcer (a peculiar progressive form of ulcer which 
spreads over the face and destroj^s the various tissues). 

It is usually applied by inserting the gold, silver, or 
platinum covered tube of radium into the cancer tissue or 
by placing it on the ulcer. 

Thorium and Mesothorium are two other radio active sub- 
stances that are used in the treatment of cancer. They are 
much cheaper than radium but not as active. 

RADIUM EMANATION 

Radium emanation is a gas which is constantly being 
given off from radium. It is obtained by placing a radium 



SPECIFICS 531 

containing substance in a bottle of water and allowing it 
to stand for some time when the water becomes charged 
with the emanation. This is used as a drink in chronic 
rheumatism and gout with beneficial results. 

The gas may also be collected from the surface of the 
water and used as an inhalation in the treatment of diseases 
of the lungs. 



CHAPTER XXIX 

SERUMS AND VACCINES 

SERUMS 

"^^nieii a patient suffers from an infectious disease, and 
then recovers, the disease has been overcome by the forma- 
tion in the blood of antibodies (antidotes) against the causa- 
tive agent of that particular infection. The patient is then 
said to have developed an active immunity against the 
disease, because he himself has formed the antibodies (anti- 
dote). 

Similarly, when an animal is injected with bacteria or 
their poisonous excretions (toxins) in gradually increasing 
doses, the animal develops an active immunity against the 
injected bacteria or their toxins. The serum of such an 
animal can then be injected into patients to overcome a 
similar infection. As a result of the injection the patient 
becomes immunized against the disease. Immunity pro- 
duced in this way is called passive immunity because it was 
the result of antibodies (antidotes) formed in the blood of 
another animal. 

A serum is the serum of an animal that has been immun- 
ized against a particular bacterium or its toxins. Serums 
are of two kinds: bacteriolytic, and antitoxic. 

BACTERIOLYTIC SERUMS 

A bacteriolytic serum is the serum of an animal that has 
been immunized against particular bacteria. The horse is 
the animal commonly used for the manufacture of serums 
since the largest quantity of serum can be obtained from, 
this animal. 

Method of Manufacture 
A horse is injected with a small dose of a solution of the 

532 



SERUMS AND VACCINES 533 

particular bacteria against which the serum is desired. 
The horse then becomes ill and has a rise of temperature, 
which disappears in a few days. When the animal is well 
again, the injection is repeated, but with a larger dose; which 
now does not produce such severe symptoms. 

The injections are repeated until the animal can stand 
injections of large doses of the bacteria without any symp- 
toms being produced. The horse is then immune against 
these particular bacteria, and his serum contains antibodies 
(antidotes) against the bacteria with which he was injected. 
The animal is then bled from the Jugular vein, the blood 
is allowed to clot, and the serum is removed under strictly 
aseptic precautions. This serum, when injected into patients 
suffering from an infection produced by the same bacteria, 
neutralizes their poisonous effects; the antibodies of the 
serum combining with the bacteria. 

Preparations 
Antistreptococcus Serum 

This serum is used in the treatment of septicaemia, 
erysipelas, scarlet fever. It is made by immunizing horses 
against Streptococci. 

Polyvalent Antistreptococcus Serum 

This is made by immunizing horses against several dif- 
ferent strains of Streptococci. 

Antistaphylococcus Serum 

This is made by inmaunizing horses against dead Staphy- 
lococci. It is used in the treatment of sepsis caused by 
Staphylococci. 

Antipneumococcus Serum 

This is the serum obtained by immunizing horses against 
dead and living Pneumococci. It is used in the treatment 
of pneumonia. 

Antigonococcus Serum 

This is the serum of rams immunized against dead and 



534 MATERIA MEDICA 

living Gonococci. It is especially valuable in the treatment 
of gonorrhoeal joints. 

Antidysenteric Serum 

This is the serum of horses inmiunized against the dys- 
entery bacillus (Shiga bacillus). 

Antimeningococcus Serum 

This is the serum of horses immunized against dead and 
living Meningococci. It is injected in 15-30 c.c. doses into 
the spinal canal, after the same amount of fluid has been 
withdrawn from the canal. 

Antityphoid Serum 

This is the serum of horses injected with dead cultures of 
typhoid bacilU. 

ANTITOXIC SERUMS 

An antitoxic serum is the serum of an animal that has been 
immunized against the poisonous excretions (toxins) of bacteria, 
but not against the bodies of the bacteria themselves. 

Antitoxic serums are prepared in the same way as antibac- 
terial serums but the animal is repeatedly injected with a 
filtrate of a bouillon culture of the bacteria obtained through 
a Berkefeld filter. This filtrate contains only the toxins of 
the bacteria, but not their bodies. 

Preparations 
Diphtheria Antitoxin Serum 

This is the serum of a horse that has been immunized 
against the toxin of the diphtheria bacilli. It contains 
antibodies against the diphtheria toxin. When the serum 
is injected into a patient suffering from diphtheria, the anti- 
bodies combine with the diphtheria toxin, thereby neutraliz- 
ing the symptoms of the disease. 

Diphtheria antitoxin is the most efficient serum which 
is used at the present time. The disappearance of the mem- 
brane in the throat, and the clearing up of all the toxic 
symptoms result in one to two days after the injection. 



SERUMS AND VACCINES 535 

It is usually given in doses of 5000 to 10000 units intra- 
muscularly, and in severe cases intravenously (an antitoxic 
unit is the amount of antitoxin that will immunize a guinea 
pig weighing 250 gms. against 100 times the fatal dose of 
diphtheria toxin). It should be repeated every 12 hours 
until all the symptoms disappear. It should always be 
given early in the disease. In the later stages the diph- 
theria toxin may have already combined with the nerve cells 
and complications may then result, but no case is hopeless. 

Diphtheria antitoxin is also given in doses of 500 to 1000 
units to those who are exposed to diphtheria cases, to prevent 
them from contracting the disease (thus immunizing them) . 

Diphtheria Antitoxin (Concentrated) 
Refined Diphtheria Antitoxin 
(Antidiphtheritic Globulins) 

These are all specially prepared antitoxins from which , 
some of the inactive serum albumins have been removed, so 
that smaller quantities of serum may be used to produce the 
same effects. 

Tetanus Antitoxin 

This is the serum of a horse that has been immunized 
against the toxins of the Tetanus bacilli. 

It is given in doses of 3000 to 20000 units every 4 to 8 hours. 
As an immunizing dose about 1500 units are given. 

BACTERIAL VACCINES 

Bacterial vaccines are solutions of dead bacteria in normal 
salt solution. A i% carbolic acid solution is usually added 
as a preservative. 

They are used to immunize patients against infections 
caused by the same kind of organisms as those that are in- 
jected. There are two kinds of vaccines: Autogenous vac- 
cines and stock vaccines. 

Autogenous vaccines are solutions of bacteria, obtained 
from the patient who is being treated. 

Stock vaccines are solutions of bacteria obtained from 
other sources. 



536 MATERIA MEDICA 

The principle upon which the action of vaccines is based, 
is the following: The injection of the dead bacteria into the 
patient, causes the formation, in the serum of the blood, of 
a substance which excites the phagocytic action (destructive 
action) of the white blood corpuscles, so that they take up 
and destroy the bacteria of the blood more readily. 

The substances formed in the serum by the dead bacteria, 
which increase the phagocytic action of the white blood cor- 
puscles, are called opsonins. 

Preparations 
Staphylococcus Vaccine 

This is a solution of dead Staphylococci and is used in the 
treatment of acne, furuncles and other Staphylococcus in- 
fections. 

Streptococcus Vaccine 

This is a solution of dead Streptococci in salt solution. 
It is used in treating Streptococcus infections. 

Typhoid Vaccine 

This is a solution of dead typhoid bacilli in salt solution. 
It is injected into patients to prevent them from contracting 
typhoid fever when they are exposed to that disease (im- 
munizing them against typhoid). 

Gonococcus Vaccine 

This is a solution of dead Gonococci in normal salt solu- 
tion and is used principally in the treatment of gonorrhoeal 
joints. 

Bacillus Coli Vaccine 

This is a solution of dead colon bacilli in normal salt 
solution. 

Pneumococcus Vaccine 

This is a solution of dead Pneumococci in normal salt 
solution. 

Coley's Serum 

This is a mixture of Bacillus prodigiosus and Streptococci, 
which is used in the treatment of sarcoma. 



SERUMS AND VACCINES 537 

Lactic Acid Bacilli 

A number of bacilli which sour milk by the formation of lac- 
tic acid, have recently been used very extensively in medicine. 
The most important organism of the group is the Bacillus bul- 
garicus. The presence of these harmless bacilli in the intes- 
tines, and their formation of lactic acid, prevent the growth 
of other harmful bacteria which cause intestinal fermentation 
and putrefaction. Cultures of these bacilli, in solid or liquid 
form are therefore given to lessen intestinal fermentation and 
to relieve various symptoms resulting from this condition. 

They are frequently given in the form of milk feimented 
with cultures of these organisms. Kumyss, Matzoon, Zoolak, 
Fermilac, etc., are similar preparations of fermented milk. 

Solid Preparations 
Bulgara Tablets 2 tablets 

A pure culture of Bacillus bulgaricus. 
Lactic Bacillary Tablets 1-2 tablets 

Fluid Preparations 
Massolin 

This is a pure culture of Bacillus bulgaricus of Massol, 
grown in broth to which calcium salts have been added. It 
is often appHed to the throat after an attack of diphtheria 
when the bacilh are still present 
Lactampoule and a number of other preparations. 

There are a number of preparations of milk on the market 
containing bulgaric bacilli, such as Fermillacj bacillac, zoolak, 
etc. 

OTHER SERUMS 
Oil Tuberculin 

This is a solution obtained by filtering a bouillon culture 
of living tubercle bacilli through a Berkefeld filter and 
adding a little glycerine to it as a preservative. It contains 
the* toxins of the tubercle bacilli. It is now only used to 
diagnose tuberculosis, either by injection, which causes a 
rise in temperature, or by the application to the skin. 
New Tuberculin 

This is made by grinding up tubercle bacilli and mixing 
them with equal parts of water and glycerine. 



538 MATERIA MEDICA 

Vaccine Virus 

This is the pus obtained from the pustules of calves 
suffering with cow pox. The pus is obtained under sterile 
precautions and a little glycerine is added as a preservative. 
It is used for vaccination against small pox. 

The principle of vaccination depends on the fact that an 
individual who has had an attack of cow pox, becomes 
immune against small pox. Vaccination produces a mild 
attack of cow pox at the site of the application of the virus. 
This makes the patient immune against small pox. 

Antirabic Vaccine 

This is an emulsion of the spinal cords of rabbits who 
have been inoculated with rabies (hydrophobia) poison. 
After the animals have been inoculated, they are killed and 
their spinal cords removed. The cords are dried, ground and 
made into an emulsion in normal salt solution. This emul- 
sion is used in the treatment and prevention of hydrophobia. 
The treatment is begun with the injection of a weak emulsion 
of a cord which has been dried for a long time, and is followed 
by the injection of stronger emulsions (containing cords 
which have been dried for a shorter time.) 

Normal Horse Serum 

This is ordinary serum obtained by coagulating horses' 
blood, and removing the serum. It is injected into patients 
to increase the clotting of the blood. 

Leucocyte Extract 

This is a fluid made by injecting aleuronat (diabetic flour) 
into the chests of rabbits. This forms a thick fluid (exudate) 
which contains a large number of white blood corpuscles. 
It is used in 10.0 c.c. doses m the treatment of pneumonia. 

Nuclein 0.3-0.6 gm. grs. v-x 

This is a compound of phosphorus and proteins which is 

said to increase the number of white blood corpuscles and 

thereby to destroy bacteria. 

Dunbar's Serum (PoUantin) : This is the serum of horses 

that have been immunized against the pollen of common 

weeds or grasses which are believed to be the cause of hay 



SERUMS AND VACCINES 539 

fever. It is used in the treatment of hay fever and is given 
hypodermically or applied locally. 

Pollen Extract or Pollen Vaccine: Pollen extracts are wa- 
tery extracts of the pollens of various plants such as ragweed, 
timothy, maize, goldenrod, etc. These pollens are believed 
to be the cause of hay fever. Pollen extracts are injected 
into patients who are susceptible to them to produce im- 
munity against Fall Hay Fever. 

The patient is first tested with an extract of each kind 
of pollen to determine which one he is susceptible to. This 
is done by scraping several very small spots on the skin of 
the arm and applying a different pollen extract on each 
spot. An area of redness and swelling (wheal) forms at the 
spot where the pollen to which the patient is susceptible 
has been applied. In this way we can determine the various 
pollens to which the patient is susceptible. The degree of 
susceptibility to the specific pollen is then tested by apply- 
ing 25%, 10%, 1% respectively, or even weaker solutions. 
About 0.3-0.6 c.c. (m. v-x) of the weakest solution which 
gives a reaction is then injected hypodermically. This solu- 
tion is gradually increased in strength with each injection 
until the patient is immunized. The effect lasts only for 
one year. 

An overdose may cause a severe attack of asthma. 

Food Proteins : A number of diseases, asthma for example, 
are believed to be due to an unusual susceptibility to various 
protein constituents of certain foods such as eggs, fish, etc. 
The susceptibility of the patient to the proteins is usually 
determined by scarifying a small spot on the arm in the 
same way as is done for vaccination, and applying a few 
minims of a solution of different proteins on these spots. 
If an elevated area of redness (wheal) occurs at the site of 
application, the patient is paid to be sensitive to the protein 
which caused it. 

The treatment with the proteins consists of injecting a 
few minims of the weakest solution that produces a reaction 
and gradually increasing the dosage until the patient is 
immunized. 



540 MATERIA MEDICA 

Administration of Serums and Vaccines 

The serums and vaccines are usually given hypodermically 
or intramuscularly. For immediate effect many serums are 
injected intravenously. 

Anaphalaxis (Serum Sickness) 

In some individuals the injection of a serum causes some 
or all of the following symptoms : 

1. Fever. 

2. Headache. 

3. Urticaria (hives). 

4. Oedema of various parts of the body. 

5. Attacks of asthma. 

6. Collapse. 

These symptoms are due to the injection into the tissues of 
a fluid that contains proteins of bacteria, animals or plants. 
Wlien such proteins are taken as food anaphalaxis may not 
occur. 

The symptoms may be avoided by finding whether the 
patient has been subject to attacks of asthma or hives, or 
whether previous injections of a serum have caused these 
symptoms. 

The susceptibility of a patient to a serum may also be 
tested by injecting a few drops of the serum hypodermic- 
ally and noting whether a small oedematous red spot oc- 
curs at the site of injection. It takes a few days, however, 
to determine this. The Schick test is a similar method 
which has been recently used quite extensively to deter- 
mine the susceptibility of individuals to diphtheria toxin, 
thus testing their susceptibility to diphtheria. Individuals 
showing a negative test are naturally immune to the dis- 
ease and need not receive an immunizing dose of diph- 
theria antitoxin when exposed to diphtheria patients. 



CHAPTER XXX 



ORGANIC REMEDIES 



There are a number of substances used in medicine that 
are obtained from various glands of animals. The various 
digestive ferments have long been used as substitutes for 
the absence of similar ferments in various diseases of the 
digestive tract. Besides these, however, substances have 
been obtained from the so-called glands of internal secretion 
or the endocrine glands. These glands secrete substances 
into the blood stream which influence in a very profound 
way the growth, development and activities of the body and 
probably also its resistance to disease. 

A number of substances have been obtained from these 
glands which have distinct curative value. Indeed, in cer- 
tain diseases they are even specifics. For example, in Myx- 
oedema or Cretinism, two diseases that result from deficient 
secretion of the thyroid gland, thyroid extract, an extract 
made from thyroid glands, is a real specific. 

On the other hand, definite substances may be obtained 
from some of the glands which have distinct pharmacologic 
effects so that these substances may be used in any disease 
where such effects are desired. For example, epinephrin or 
adrenalin is a substance obtained from the adrenal glands of 
sheep. It contracts the blood vessels and acts as a heart 
stimulant producing effects quite similar to those of digitalis. 
Pituitrin is another substance which is obtained from the 
pituitary gland, a small gland situated at the base of the 
brain, which causes definite contractions of the involuntary 
muscles of the intestines and the uterus. It is therefore used 
with brilliant effects to produce uterine contractions and to 
expel the contents from the intestines. The number of sub- 
stances that are being obtained from the glands of internal 
secretion that are of distinct value are increasing from day 
to day. 

541 



542 MATERIA MEDICA 

Furthermore, since the glands for internal secretion play 
such an important role in the development, the activities 
and the immunity of the body, it is becoming more and 
more evident that in many diseases the disturbance in the 
function of one or several of the glands of internal secretion 
may be an important direct or associated causative factor 
in these diseases. 

The administration of gland extracts gives such brilliant 
specific curative effects in those cases where the disturbance 
of the gland is recognized as in the treatment of Myxoedema 
with thyroid extract for instance. Consequently the ad- 
ministration of glandular extracts is often equally beneficial 
in other diseases where signs of an associated deficiency of 
the glands for internal secretion are present besides the 
usual symptoms of the disease. For example, overactivity 
of the thyroid gland is characterized by a rapid pulse, twitch- 
ings of the fingers, bulging of the eyeballs, sweating and 
nervousness. Consequently the occurrence of some of these 
symptoms in any disease such as stomach disease for instance, 
indicates that the over-acting thyroid gland is either a direct 
or an associated cause of this disease. Or, since Myxoedema 
or hypothyroidism is characterized by mental sluggishness, 
drowsiness and the formation of fat pads and dryness of the 
skin, the presence of these symptoms in any other disease 
indicates that the deficient thyroid secretion plays an im- 
portant role in the cause of this other disease. And so, in 
many diseases we may frequently find, sometimes slight, at 
other times marked evidence of deficient function of some 
of the glands of internal secretion. 

There is therefore an increasing tendency on the part of 
many physicians to prescribe glandular substances in many 
diseases other than those due to disease of the glands for 
internal secretion. The gland that is prescribed in any 
disease is the one whose secretion is apparently deficient. 
This is determined by the presence of a number of symp- 
toms that indicate its deficiency, such as the mental slug- 
glishness, fat pads, dryness of the skin, etc., for example, 
which indicate thyroid deficiency. 



ORGANIC REMEDIES 543 

THYROID EXTRACT 

Thyroid extract is a powder made by grinding up the 
thyroid glands of sheep. The active principle is a substance 
called thyroxin which has recently been isolated. 

ACTION 

The thyroid gland is a ductless gland which secretes a 
substance into the blood. This substance regulates the 
growth and development of the body and it probably also 
influences the function of many other organs of the body. 
It increases the metabolism of proteins and fats, thereby 
causing a loss in weight. It also aids in the growth of bone. 
The effect of the thyroid gland on the body can best be 
understood by a study of the symptoms which result when 
the thyroid is absent, when it is atrophied, or when it is 
acting excessively. 

When the thyroid gland is absent or very poorly developed 
which is not infrequently the case in children, a condition 
known as cretinism develops due to the fact that the thyroid 
gland is not functionating. These children are stunted in 
their growth, they develop pads of fat in the neck and other 
parts of the body, they have a slow pulse, they are dull and 
stupid, their intelligence is very poor and they make no 
progress in school. 

The continued administration of thyroid extract to such 
children is followed by startling improvement in their 
growth and development; indeed all the symptoms of the 
condition gradually disappear. 

In old people the thyroid gland frequently becomes 
atrophied; thus diminishing its secretion. These individuals 
suffer from symptoms similar to those that occur in Cretin- 
ism. They become drowsy, they are dull mentally, they 
become stout and pads of fat develop in the neck and other 
parts of the body. This condition is called Myxoedema and 
is promptly relieved by continued administration of thyroid 
extract. 

When the thyroid gland secretes excessively a condition 
known as Hyperthyroidism occurs. In severe cases the 



544 MATERIA MEDICA 

thyroid gland is very much enlarged and the eyeballs bulge 
out (exopthalmos) . Consequently the disease is frequently 
called Exopthalmic Goitre; also Grave's or Basedow's disease 
after the men who first described the condition. The 
principal symptoms of this disease are a rapid pulse, ner- 
vousness, very fine twitchings of the fingers, bulging of the 
eyeballs, diarrhoea, profuse sweating and in severe cases 
enlargement of the thyroid gland. 

Effects 

When th}Toid gland is given to patients who have an ap- 
parently normal thyroid secretion it may cause a slight loss 
in weight and it slightly increases the rapidity of the pulse. 

Uses 

Thyroid extract is used in a great many conditions but 
the diseases in which it is distinctly indicated are those in 
which there is a deficient secretion of the thjToid gland. 
These conditions are Myxoedema and Cretinism and th;>Toid 
is a specific for them. If the treatment is begun early enough 
the symptoms all disappear but it must be kept up for the 
rest of the patient's life since the thjToid extract merely 
substitutes the deficient secretion. 

Since the feeding of thyroid extract to patients with 
Myxoedema causes the disappearance of the deposits of fat, 
thyroid extract is frequently used to reduce weight in obesity. 
It must be used with great care in this condition since poi- 
sonous symptoms may occiu' before the weight has been 
appreciably reduced. 

Many patients suffering from other diseases such as va- 
rious forms of stomach disease may show some of the symp- 
toms characteristic of deficient thyroid secretion such as 
abnormal drowsiness, mental dullness, dr>mess of the skin, 
etc. These symptoms are believed to indicate that the de- 
ficient th}Toid secretion is an important causative factor in 
these diseases. Consequently they are treated with thyroid 
extract and very often with beneficial results. 

Thyroid extract is also used in various other diseases such 
as chronic arthritis (chronic inflammation of the joints) be- 



ORGANIC REMEDIES 545 

cause these diseases are supposed to be due to a disturbance 
in the thyroid secretion. It is also given to stimulate the 
healing of ununited fractures and in osteomalacia and 
rickets, two conditions of undue softening of the bones. 

Thyroid extract is also used in disturbances of various 
other glands of internal secretion on the theory that ex- 
cessive action of these glands results from an effort to com- 
pensate for a deficient thyroid secretion, or that thyroid 
extract helps their function. 

Poisonous Effects 

When excessive doses of thyroid extract are taken symp- 
toms of excessive thyroid secretion result. The symptoms 
are the same as those which occur in Hyperthyroidism or 
Exopthalmic Goitre. When these symptoms occur the ad- 
ministration of thyroid extract should be stopped. 

Symptoms 

1. Rapid loss in weight. 

2. Rapid pulse. 

3. Nervousness. 

4. Twitching of the fingers. 

5. Bulging of the eyeballs. 

6. Diarrhoea. 

7. Enlargement of the thyroid gland. 

Preparations 

Thyroid Extract 0.006-0.3 gm. grs. ^^-v 

(Glandulae Thyroidae Siccae) 

Antithyroidin Moebius 0.5-1.0 c.c. m. viii-xv 

This is the serum of goats in whom the thyroid glands 
have been removed about six weeks before the serum is re- 
moved. It is used in the treatment of exophthalmic goitre 
(excessive thyroid secretion). 

Thyroidectin 0.3 gm. grs. v 

This comes in gelatin capsules which contain a powder 
made from the dried blood of animals whose thyroid glands 



546 MATERIA MEDICA 

have been removed. It is used in cases of excessive thyroid 
secretion (Hyperthyroidism or Exopthalmic Goitre). 

PARATHYROID EXTRACT 

Parathyroid extract is a powder made from an extract of 
the parathyroid glands. These are very small glands sit- 
uated in the region of the thyroid gland. 

ACTION 

The action of the parathyroid glands can best be under- 
stood by a study of the symptoms that result from their 
removal. This often happens in the removal of the thyroid 
gland, in which the parath^Toids are hnbedded. The re- 
moval of the parath^Toids is followed by a condition known 
as tetany. This condition also occurs spontaneously in 
children. It is characterized by the occurrence of inter- 
mittent or spasmodic or tetanic contractions of the muscles 
of the arms and hands, sometimes also of the lower extrem- 
ities. 

These symptoms are due to the deficient secretion of the 
parath^Toid glands which regulate the metabolism of cal- 
cium salts. As a result of the consequent deficient calcium 
in the body the nerves become more irritable; since calcium 
is a necessary substance for proper action of nerve tissues. 

Parath3T:-oid extract is also given to lessen the twitchings 
of the hands in paralysis agitans, a disease characterized 
by continual twitchings of the hands and a shufiling gait. 
It is also used to lessen the convulsions of eclampsia, a 
condition occurring in pregnancy. 

Preparations 

Parathyroid Extract 0.003-0.006 gm. gr. 4^-^ 

Dessicated Parathyroid Gland 

PITUITARY EXTRACT 

Pituitary extract is a powder made from the pituitary 
gland of the ox. The pituitary gland is a small gland sit- 



ORGANIC REMEDIES 547 

uated dt the base of the brain. It is a ductless gland which 
secretes a substance which enters the blood stream. The 
gland consists of two parts : an anterior lobe and a posterior 
lobe. Each lobe has a different function. The active prin- 
ciple of the anterior lobe is a substance called tethelin. The 
posterior lobe contains a substance known as pituitrin 
which produces definite effects. 

The effect of the pituitary gland on the body can best 
be understood by a study of the symptoms which result 
when the pituitary gland is secreting excessively or when 
its secretion is deficient. Since each lobe of the gland has 
a different function, the effects differ according to whether 
the anterior or posterior lobe of the gland is involved. 

The anterior lobe of the gland regulates growth and de- 
velopment particularly of the bones; for when the secretion 
of this lobe is excessive, the growth of the bones is increased. 
As a result the individual is of large stature with large ex- 
tremities out of proportion to the rest of the body. 

The posterior lobe of the gland secretes a substance into 
the blood which causes contraction of all the involuntary 
muscles. It therefore causes contractions, it raises the blood 
pressure, it contracts the bladder and it increases the meta- 
bolism and indirectly stimulates the action of the genital 
glands. It also increases the flow of urine and the secretion 
of milk. 

When the anterior lobe of the pituitary gland secretes ex- 
cessively a condition known as acromegaly or gigantism de- 
velops. This is characterized by excessive growth of the 
skeleton. The individual is of large stature, he has ab- 
normally long extremities so that the individuals are the 
so-called giants, if the disturbance in the gland occurs in 
childhood before the bones have completely ossified. If the 
disturbance in the gland occurs later in life, about the period 
of adolescence, a condition known as acromegaly develops. 
The patient is not usually of large stature but the bones of 
the face are enlarged and thickened so that the features 
become coarse, large and prominent (the so-called lion-like 
face). The fingers and the toes become thick, broad and 
square and the hair over the body is profuse and bushy. 



548 MATERIA MEDICA 

When the secretion of the anterior lobe of the pituitary 
gland is diminished, usually as a result of a very small- 
sized or atrophic gland, if this disturbance occurs in in- 
fancy the individuals remain dwarfs. If it occurs later in 
life the individuals have small, thin hands, small teeth packed 
close together, highly arched palate and have a subnormal 
mentality and show defective bone development generally, 
with scanty growth of hair and a tendency to obesit}^ 

When there is a disturbance of both lobes of the pituitary 
gland usually as a result of disease, the secretion is markedly 
diminished and the condition known as Hypopituitarism or 
dystrophia adiposogenitalis or Froehlich's disease results. 
This is characterized by localized deposits of fat usually 
about the breasts and buttocks with a change in the physical 
characteristics of the individual that determine the sex. 
The skin is dry scaly alabaster like. There also develops a 
peculiar blindness in which patients do not see objects on 
either side of them, due to pressure on the optic nerve. If 
the patient is a woman the breasts become smaller, she stops 
menstruating and develops a growth of hair on the face. 
In male patients the growth of hair on the face diminishes 
the breasts become larger and the sexual glands become 
atrophied. 

These symptoms gi'adually improve with the adminis- 
tration of the pituitary gland extracts especially of the an- 
terior lobe since most of the symptoms are due to deficient 
secretion of the anterior lobe. 

Uses 

Anterior lobe extract is used as a specific to supply de- 
ficient secretion of the anterior lobe in Hypopituitarism, in- 
fantilism, dwarfism and in the late stages of acromegaly. 

Posterior pituitary lobe extract is used as a heart stimu- 
lant in shock or collapse and to raise the blood pressure. 
It is also used to increase peristalsis in abdominal distention 
(tympanites) following operations and in the course of va- 
rious infections, and to increase uterine contractions in labor. 
It is used to check the excessive secretion of urine in diabetes 
insipidus which is believed to be due to deficient action of 



ORGANIC REMEDIES 549 

the posterior lobe of the pituitary gland. It is also given 
in epilepsy. 

Since deficient action of the pituitary gland is charac- 
terized by characteristic symptoms, the presence of these 
symptoms in any disease is considered by some physicians 
to play a causative role in the disease and consequently 
pituitary extracts are used in the treatment of many other 
diseases. 

Poisonous Effects 

When excessive doses of pituitary extract is given there 
usually occurs a characteristic headache in both temples 
which indicates that the drug should be stopped. 

Preparations 
Pituitary Body Dessicated 0.06-0.2 gm, grs. i-iii 

This is the dried substance of the entire pituitary gland 
of the ox. It comes in tablets. 

Dessicated Pituitary Substance (Anterior Lobe) 

0.06-0.25 gm. grs. i-iv 

This is the powdered dried substance of the anterior lobe 
of the pituitary gland of the ox. It also comes in tablets. 

Dessicated Pituitary Substance (Posterior Lobe) 

0.06-0.25 gm. gr. i-iv 

This is the dried powdered posterior lobe of the pituitary 
gland of the ox. 

Dessicated Hypophysis 0.03 gm. gr. ^ 

Hypophysis Sicca 

This is a yellowish powder made from the posterior lobe 
of the pituitary gland. 

Solution of Hypophysis 1.0 c.c. m. xv 

Liquor Hypophysis 

This is a sterile solution of the extract of the posterior 
lobe of the pituitary gland. It comes in ampoules each con- 
taining 1.0 c.c. (m. xv). 



550 MATERIA MEDICA 

The following are preparations of solution of hypophysis: 

Pituitary Liquid 
Solution Pituitary Extract 
Pituitrin 

ADRENAL EXTRACT 

Adrenal extract is made from the dried suprarenal or 
adrenal glands of the sheep and ox. These glands are sit- 
uated immediately above the kidneys and they consist of 
two portions: an outer part or cortex, and an inner portion 
or medulla. The cortex and medulla each secrete a sub- 
stance into the blood which has a profound effect upon the 
function of the body. 

The function of the cortex is not definitely known but 
it is believed to play a part in the development and gTowth 
of the sexual organs. The medulla of the gland secretes a 
substance into the blood which acts on all the involuntary 
muscles by stimulating their nerve terminals of the sym- 
pathetic system. Epinephrine or adrenalin is a substance 
obtained from the medulla of the gland which produces the 
same effect. It contracts the involuntary muscles in the 
small blood vessels, raising blood pressure for a short time, 
slowing the pulse, dilating the pupil, increasing the secre- 
tions such as the saliva, the tears and contracting the in- 
voluntary muscles of the intestines. 

When the secretion of the adrenal glands is deficient which 
not infrequently is the result of disease, a condition known 
as Addison's disease results. This is characterized by ex- 
treme weakness and particularly by weakness in the muscles, 
by low blood pressure, by bronze coloring of the skin, and 
finally death. 

Lesser degrees of insufficient adrenal secretion occur, 
characterized by extreme weakness, low blood pressure, sen- 
sitiveness to heat and cold, anaemia and constipation, which 
are more amenable to treatment. 

Adrenal extract is used in the treatment of these condi- 
tions, but in Addison's Disease the condition is so progres- 
sive that it is not of much value. 



ORGANIC REMEDIES 551 

Epinephrine or Adrenalin is used as a heart stimulant, as 
a local application on mucous membranes in the nose and 
throat and in asthma and urticaria (see page 240) . 

Excessive secretion of the adrenal glands occurs but very 
little is definitely known about it. 

Preparations 

Dried Suprarenal Gland 0.015-0.25 gm. gr. |-iv 

Suprarenalum Siccum 

Solution of Epinephrine 

hydrochloride 0.12-1.0 c.c. m. ii-xxx 

Solution of Adrenalin chloride 

These are 1-1000 solutions of epinephrine or adrenalin. 

OVARIAN EXTRACTS 

Ovarian extract is a powder obtained as an extract from 
the ovary. 

The ovaries are two glands situated at the side of the 
uterus. They secrete the ova into the uterus. Besides the 
secretion of the ova the ovaries secrete a substance into 
the blood which has a profound effect on the function of 
all the other genital glands. This internal secretion also in- 
fluences many of the other functions of the body; particu- 
larly the nervous system and metabolism. It is believed 
that the internal secretion of the ovaries originates in the 
corpus luteum, which is a small body formed in the ovary 
at the site of the discharged ovum. During pregnancy this 
body undergoes rather characteristic changes. 

ACTION 

The action of the internal secretion of the ovary can be 
understood by a study of the symptoms that result when 
this secretion is diminished. This occurs at the time of the 
menopause which is the period when a woman ceases to 
menstruate and after both ovaries have been removed dur- 
ing an operation. At this time as a result of the deficient 
internal secretion of the ovary, the patient ceases to men- 



552 MATERIA MEDICA 

struate, she becomes very nervous and irritable; she gets 
flushing of the face and becomes unusually stout. 

It is also believed that amenorrhoea (cessation of men- 
struation) scanty, irregular and painful menstruation 
(dysmenorrhoea) and the vomiting of pregnancy are due 
to a disturbance of internal secretion of the ova^ries. 

Ovarian extract is used to relieve the nervous symptoms, 
the flushes and the obesity which occur at the menopause 
whether natm^al or following the removal of the ovaries. 

It is also used to relieve scanty, painful and irregular 
menstruation as well as various skin diseases which occur 
at the time of the menopause. 

Preparations 

Ovarian Substance 0.06-0.2 gm. grs. i-iii 

Ovarian Extract 

Corpus Luteum 

Corpus luteum is an extract made from the corpus luteum 
of the cow. These are small yellow bodies which are formed 
in the ovary at the site of the discharged ovum. It is be- 
lieved that the internal secretion of the ovary is formed in 
the corpus luteum. Consequently it is used in the same 
conditions as ovarian extract but it is believed to be better. 

Preparations 

Corpus luteum dessicated 0.12-0.3 gm. gr. ii-v 

This comes in capsules or tablets made from the fresh 
corpulutea of cow's ovaries. 

Lutein 0.12-0.3 gm. gr. i-v 

This is made from the corpus luteum. of the hog but it is 
4 times as strong as the fresh substance. 

THYMUS EXTRACT 

Thymus extract is a powder made from the fresh thymus 
gland of the calf. The gland is situated in the chest, behind 
the sternum. It regulates the growth and development of 



ORGANIC REMEDIES 553 

the child. Since it regulates growth and development of 
bone it is used in the treatment of chronic rheumatism with 
bony changes and in rickets. 

MAMMARY EXTRACT 

Mammary extract is a yellowish powder made from the 
mammary glands (breasts) of sheep. 

The nursing of the child and the flow of milk from the 
breast causes contraction of the uterus; an effect which is 
believed to be due to an internal secretion of the breast. 
Consequently mammary gland extract is given to contract 
the uterus and therefore to check profuse menstruation 
(menorrhagia) and the excessive bleeding occurring at the 
time of the menopause. 

Mammary substance 0.12-0.3 gm. grs. ii-v 



PART X— DRUGS ACTING PRINCIPALLY ON THE SKIN 
AND MUCOUS MEMBRANES 

LOCAL REMEDIES 
CHAPTER XXXI 

ASTRINGENTS 

Astringents are drugs which are used to contract the 
tissues with which they come in contact. If they are ap- 
phed to mucous membranes, by contraction of the cells, 
they lessen the secretions. 

Astringents affect the tissues only locally, by combining 
with the proteins or albumins of the cells and thereby co- 
agulating and hardening them. Such an effect can only be 
produced when the substance comes in direct contact with 
the tissues upon which it acts. 

In large doses, the excessive coagulation of the proteins 
of the cells destroys the tissues; this effect is called caustic 
action. 

Astringents may be divided into two groups, depending 
upon the nature of the substance used for this purpose: 

Inorganic or Mineral Astringents 
Organic or Vegetable Astringents 

INORGANIC OR MINERAL ASTRINGENTS 

Mineral astringents are mineral substances which are 
used to contract tissues and to check the secretions of mu- 
cous membranes. Most of these substances are metals and 
their salts. The principal salts used for this purpose are the 
salts of lead, silver, aluminum, zinc, copper and bismuth. 
Mercury, iron and arsenic are also astringents, but these are 
used principally for their effects after absorption. The 
metals usually act by coagulating the albumins of the 
cells, forming an albuminate of the metal. Many of their 

554 



ASTRINGENTS 555 

preparations are already combined with albumins. These 
are not as injurious to the tissues and are milder in ac- 
tion. 

The best astringents are those that are not readily ab- 
sorbed, such as silver, bismuth, copper and zinc. The two 
latter substances are the most active astringents. In strong 
solutions they destroy the tissues. 

The metals that are readily absorbed are mercury, iron, 
arsenic and lead. Lead is the only one that is used as an 
astringent, the others are used principally for their effects 
after absorption. 

Of the various salts of the metals, the chlorides and the 
nitrates have the most astringent action, while the effect 
of the sulphates and other salts are not as marked. 

ACTION 

Local action : Applied to the skin, solutions of the metallic 
astringents produce no effect, but on ulcers or wounded 
surfaces they coagulate the albumins of the superficial layer 
of cells, thus contracting them. In this way, they form a 
thin covering of coagulated albumin, which protects the cells 
from injury and promotes their healing. If applied to a 
bleeding spot, they stop bleeding by coagulating the albumins 
of the blood. Mucous membranes are contracted, and their 
secretions checked, by coagulation of the albumins of their 
cells. 

Internal Action 

In the mouth: They have a sweet metallic taste, and 
make the mouth feel dry by contracting the mucous mem- 
brane. 

In the stomach and intestines: They check the secre- 
tions and lessen peristalsis, thereby causing constipation. 
They combine with the protein of the food which is then not 
as readily digested. 

Absorption 

The mineral astringents combine with the albumins in 
the stomach and intestines forming albuminates. 



556 MATERIA MEDICA 

If the resulting compounds are readily dissolved in the 
albuminous fluids which surround them, the metals will 
be readily absorbed, otherwise they merely act locally. 
They do not produce any effects, however, unless 
given for a long time, when they may be deposited in the 
various tissues of the body and serious poisonous symptoms 
may develop from some of them. These symptoms will be 
considered under the various substances from which they 
occur. 

Excretion 

The metallic astringents that are absorbed are very slowly 
eliminated from the body; in the urine, the bile, the intes- 
tinal secretions, the sahva and the milk. 

Poisonous Effects of Metallic Salts 

When large doses of the salts of any of the metals are taken, 
the following symptoms occur: 

1. Burning pain in the mouth. The mouth may be cov- 
ered with a grayish white membrane, especially after taking 
silver preparations. 

2. Severe abdominal pain. 

3. Nausea and vomiting. Often the vomited matter 
contains blood. 

4. Diarrhoea with bloody stools. 

5. Collapse. 

6. Coma and death. 

Treatment 

1. Wash out the stomach. 

2. Give milk, egg white or old tea to combine with the 
metal and neutralize it. These substances protect the mu- 
cous membrane of the oesophagus and stomach at the same 
time. 

3. The collapse is usually treated with stimulants. 

4. Give the chemical antidote. 

The following is a hst of the chemical antidotes for some 
of the metals. For the others there is no chemical antidote. 





ASTRINGENTS 


Metal 


Antidote 


Lead 


Dilute sulphuric acid 


Silver Nitrate 


Sodium chloride (salt) 


Alum 


Magnesium Hydrate or 




Ammonium carbonate 




METALS 



557 



SILVER (ARGENTUM) 

Silver is a white, hard, glistening metal. The only salt of 
silver which is used to any extent in medicine is the silver 
nitrate. 

Silver has been used in medicine for centuries, particularly 
by the Arabians, who used it extensively in the treatment of 
nervous diseases. In their system of medicine, which was 
based upon astrology, silver and nervous diseases were 
associated with the phases of the same planet, the moon; 
hence the name lunar caustic for silver nitrate. 

Chronic Silver Poisoning (''Argyria") 

Argyria is a condition which results from prolonged use 
of silver salts, but the condition is not very common at the 
present time. 

The silver salts are absorbed into the blood, and deposited 
in the various tissues of the body. Since silver salts turn 
a dark color on exposure to light, the skin turns a dark gray 
or slate color. The skin of the entire body or only va- 
rious regions of it, such as the face or the gums, may be thus 
affected. 

To relieve the condition potassium iodide is usually given, 
but it does not usually respond to treatment, however. 

Uses 

Silver salts are used to check the growth of granulation 
tissue (newly formed connective tissue) and to contract the 
mucous membranes of the eye, the nose, or the mouth when 
these are inflamed. 

The salts of silver are particularly valuable in the treat- 
ment of gonorrhoeal infections. They destroy the gonococci; 
the bacteria which cause the disease. 



558 MATERIA MEDICA 

Preparations 

The preparations of silver are divided into inorganic and 
organic preparations. The inorganic preparations are the 
ordinary salts formed by the combination of silver with a 
mineral acid. The organic preparations are formed by the 
combination of silver with albmnin. 

Inorganic Preparations 

Silver Nitrate 0.01-0.03 gm. grs, i-} 

(Argenti Nitras) 

This is used in 1 to 2% solutions dropped in the conjunc- 
tiva of the eye, in newly born infants, to prevent gonorrhoea! 
opthalmia. In other gonorrhoeal infections and for other 
conditions, it is used in much weaker solutions such as 
1-10000 to 1-1000. 

Silver nitrate forms an explosive compound with tannic 
acid. 

Moulded Silver Nitrate 
(Argenti Nitras Fusus) 
(Lunar Caustic) 

This comes in hard white sticks in the form of pencils. 
It is used to destroy excessive granulation tissue and other 
tissues. 

Mitigated Silver Nitrate 
(Argenti Nitras Mitigatus) 

(Mitigated Caustic) 

This consists of one part of silver nitrate and two parts of 
potassium nitrate, fused into pencils hke lunar caustic. 

Silver Oxide 0.03-0.12 gm. grs. Hi 

(Argenti Oxidum) 

Organic Preparations 

New and Non-official Preparations ,• 

These preparations are combinations of silver with al- 
buminous substances. They are therefore not as injurious 
(irritating) to the tissues, and can be used in stronger solu- 
tions as antiseptics. 



ASTRINGENTS 559 



Arg3rrol 
Silver Vitellin 



This is a compound of silver oxide and proteins, contain^ 
ing 20-25% of silver. 

It is used locall}^ as an antiseptic and astringent to mucous 
membranes, in 10-25% solutions; which are not injm"ious to 
the tissues. Argyrol should be very carefully used, as it 
staiiia linen a dark brown color. 

Protargol 
Protein Silver Salt 

This is a compound of albumin and silver containing 
8.3% of silver. It is used as an antiseptic, and as an 
astringent on mucous membranes in 1 to 10% solutions; as 
irrigations in 1-1000 to 1-2000 and in the form of bougies 
and tampons in 5-10% solutions. 

CoUargol (colloidal silver Crede) 0.06 gm. gr. i 

(CoUargolum) 

This is a solution of very finely divided silver, in albumin, 
containing about 85% of silver. It is used as an antiseptic 
both locally, and injected into the blood. 

It is often given by direct injection into the veins, in cases 
of sepsis, in i% solutions. It is also used in the form of 
bougies, vaginal suppositories and dusting powders. 

Collargol Ointment 
(Unguentum Crede) 

This contains 15% of collargol. It is used principally in 
acute mastitis, or inflammation of the breast. 

About 2.0-4.0 gms. (grs. xxx-5i) are rubbed thoroughly on 
cne skin. 

Albargin 
Gelatinose Silver 

This is a compound of gelatose with silver, which con< 
tains 13-15% of silver. 

Argentamin 

(Liquor Argentamini) 



560 MATERIA MEDICA 

This is a watery solution of silver nitrate and ethylen 
diamine containing 10% of silver nitrate. It is used in 
i-4% solutions as an antiseptic in gonorrhoea. 

Argonin 
Silver Casein 

This is a compound of silver and casein, containing about 
4% of silver. It is used in i-20% solutions. 

Silver Citrate 
Itrol 

This is used as injections in 1-4000 to 1-1000 solutions 
as an antiseptic. 

Silver Lactate 
Actol 

This is used in 1-300 to 1-500 solutions as an antiseptic 
Cargentos. 

This is a 50% albuminous solution of silver with casein. 
It is used as an antiseptic, in the form of tablets, vaginal 
tampons, dusting powder, ointment or suppositories. 

Novargan (Silver Proteinate) 
(Argenti Proteinas) 

This is a compound of silver and albumin, containing 
10% of silver. It is used as a urethral injection in 15% 
solutions. 

Hegonon 

Silver Nitrate Ammonia Albumose 

This is an albumin silver preparation which contains 7% 
of silver. It is used in 1-6000 to 1-2000 solutions. 

Icthargan (Silver Icthyolate) 
Argenti Ichthyosulphonas 

This contains 30% of silver and 15% of sulphur. It 
is used in 1-4000 to 3% solutions. 

Sophol 

This is a compound of silver and methylen nucleic acid. 
It is used an antiseptic and astringent in 2-5% solutions, in 
inflammations of the eyes. 



ASTRINGENTS 561 

ALUMINIUM AND ALUM 

Aluminium is a light metal. The omy salt of aluminium 
which is used in medicine, is the aluminium and potassium 
sulphate, or alum. 

Uses 

Alum is used principally as an astringent to contract mucous 
membranes. 

It is used as a gargle in 1 to 5% solutions. 

For douches, and as a lotion on the skin and other mucous 
membranes, it is used in J-1% solutions. 

Large doses of alum are occasionally used to produce 
vomiting. 

Preparations 

Alum 0.3-1.0 gm. grs. v-xv 

(Alumen) 

This is aluminium and potassium acetate. Alum is very 
injurious to the teeth, and when given internally, it should 
be given through a glass tube. 

Dried Alum or Burnt Alum 
(Alumen Exsiccatum) 

This is alum which has been dried by heat. It absorbs 
moisture from the air. It is often combined with 1-5 parts 
of alcohol to harden the skin, and prevent bedsores. 

The other salts of aluminium, such as the aluminium 
acetate and the aluminium chloride are used as antiseptics. 

Aluminium Hydroxide 0.3-1.0 gm. grs. v-xv 

(Aluminii Hydroxidum) 

Aluminium Sulphate 
(Aluminii Sulphas) 

This is used only locally. 

Solution of Aluminium Acetate 
(Liquor Aluminii Acetas) 

(Burrow's solution) 

This is used in |-2% solutions as an antiseptic. 



562 MATERIA ]\IEDICA 

New and Non-official Preparations 
Alunmol 
Alumini Naphtholsulphonas 

This is used as an astringent and mild antiseptic ^ in ^-5% 
solutions, for dressings, gargles, douches, etc. 
It is used as a caustic in 10-20% solutions. 

LEAD (PLUMBUM) 

Lead is a heavy metal which forms salts by combining 
with acids, many of which are used in medicine. 

Chronic Lead Poisoning 

Chronic lead poisoning is the most common form of 
poisoning by metals. It occurs particularly in workers 
who are forced to handle lead or its salts, such as white 
lead or type, contmuously. Painters, type setters, plumbers 
and glaziers are frequently affected, the lead being absorbed 
from the skin, or from the stomach or intestmes when it gets 
on the food from the hands. 

Occasionally, lead poisoning results from drinking water 
coming thi'ough lead pipes, or eating canned food from cans 
soldered ^dth lead, or from food adulterated wdth lead; such 
as cakes colored with chromate of lead, etc. It often occurs 
from inhaling lead fumes in a room painted with lead paint, 
and from the absorption of ointments or solutions applied 
to wounds or ulcers. 

The symptoms appear very slowly and vary in different 
uidividuals. They result from the lead affecting the ali- 
mentary tract, the blood and the nerves. 

Symptoms 
Symptoms of the Alimentary Tract 

1. Loss of appetite, nausea, metaUic taste in ^the mouth 
and bad breath. 

2. " Lead line " on the gums. This is a dark blue line of 
lead sulphide which is deposited at the junction of the gums 
and teeth. It may be absent if the teeth are kept very clean. 



ASTRINGENTS 568 

3. " Lead Colic " or painter's colic. 

This is a very characteristic symptom, and usually ap- 
pears suddenly. The patient complains of severe cramp- 
like abdominal pains, usually beginning around the navel, and 
lasting for several days, after which they disappear but soon 
return. 

4. Obstinate constipation. 

5. Occasionally vomiting. 

6. Slow strong pulse. 

Symptoms of the Blood 

1. Anaemia: The blood cells often contain very small 
granules of lead. 

2. Occasionally, abortion in pregnant women. 

Symptoms of the Nerves 

These symptoms appear later. 

1. Lead paralysis, lead palsy or painter's palsy. The 
extensor muscles of both forearms usually become paralyzed, 
and the hands drop as a result of the contractions of the 
flexor muscles (^^^d'op wrists"). Other muscles may be 
similarly affected. 

2. Loss of sensation in areas of the skin. 

3. Sharp, shooting or boring pains around the joints 
(arthralgia). 

4. Rarely, blindness, from affection of the optic nerve. 

5. " Encephalopathia Saturnina." These are various symp- 
toms which occur very rarely, and are the result of the 
effect of lead on the brain. 

Headache, dizziness, sleeplessness, deafness, stupor, weak- 
ness. Occasionally nausea, delirium,, convulsions, hallucina- 
tions, etc. 

In individuals who have had repeated attacks of lead 
poisoning, or who aro exposed to lead continuously, the 
destruction of the cells in various organs of the body, and 
their replacement by connective or scar tissue, results in 
various chronic diseases. Thus, chronic nephritis often 
results from the destruction of many of the kidney cells. 



564 MATERIA MEDICA 

Arteriosclerosis or hardening of the arteries, often results 
from the destruction of the cells of the blood vessel walls, 
and their replacement by connective tissue. 

Treatment 

1. Individuals who are continually exposed to lead or its 
salts, can often avoid poisonous symptoms by keeping their 
hands and nails scrupulously clean, especially before eating; 
to avoid getting the lead particles in the mouth. They should 
move the bowels regularly, best by epsom salts, and they 
should take dilute sulphuric acid in lemonade regularly. 
Their diet should contain plenty of milk. 

The patients suffering from an attack of chronic lead 
poisoning should be treated in the following way : 

1. The bowels should be moved regularly by magnesium 
or sodium sulphate, which also helps to neutralize the lead, 
forming lead sulphide, which is then excreted in the in- 
testines. 

2. Potassium iodide is given, which helps to ehminate 
the lead. 

3. The lead colic is best controlled by atropine. 

4. For the anaemia, iron is given. 

5. The paralyses usually get well if carefully treated 
with electricity and massage. 

Uses 

Lead salts are used principally on ulcers and wounds, to 
contract the tissues, and to check bleeding. 

The lead acetate is occasionally given to check diarrhoea. 

Preparations 

Lead Acetate 0.06-0.3 gm. grs. i-v 

(Plumbi Acetas) 
(Sugar of Lead) 

For Local Use : 
Solution of Lead Subacetate 
(Liquor Plumbi Subacetatis) 
(Goulard's Extract) 



ASTRINGENTS 565 

This contains about 25% of lead subacetate. It should 
be diluted, about § J being used to a pint of water. 

Dilute Solution of Lead Subacetate 
(Liquor Plumbi Subacetas Dilutum) 

This contains § part of lead subacetate to 1000 c.c. of 
water. 

Cerate of Lead Subacetate 
(Ceratum Plumbi Subacetas) 

(Goulard's Cerate) 

This consists of lead subacetate solution, wool fat, white 
vaseline and camphor. 

Lead Iodide 
(Plumbi lodidum) 

Lead Plaster 
(Emplastrum Plumbi) 

(Diachylon Plaster) 

This consists of lead oxide, soap and water. 

Adhesive Plaster 
(Emplastrum Adhaesivum) 

This consists of rubber, lead plaster, and vaseline. 

Soap Plaster 
(Emplastrum Saponis) 

This consists of soap, lead plaster and water. 

Diachylon Ointment 
(Unguentum Diachylon) 

This consists of lead plaster, olive oil and oil of lavender. 



ZINC (ZINCUM) 

Zinc is a metal which forms salts, many of which are used 
in medicine. 



566 MATERIA MEDICA 

Chronic Zinc Poisoning 

Chronic zinc poisoning occasionally occurs among workers 
who handle zinc. It causes symptoms like those of lead 
poisoning. 

Uses 

Zinc sulphate is used to produce vomiting. The other zinc 
salts are used as astringents in various skin diseases and 
ulcers. 

Preparations 

Zinc Sulphate (as an emetic) 0.3-2.0 gms. grs. v-xxx 

(Zinci Sulphas) 

It is used as an eye wash in i-i% solutions and as an 
injection in gonorrhoea in 1-4% solutions. 

Zinc Oxide 
(Zinci Oxidum) 

Zinc Oxide Ointment 
(Unguentum Zinci Oxidum) 

This contains 1 part of zinc oxide to 4 parts of benzoinated 
lard. 

Precipitated Zinc Carbonate 
(Zinci Carbonas Precipitatus) 

Zinc Stearate 
(Zinci Stearas) 

This is used as a dusting powder on ulcers, and on various 
skin diseases. 

Zinc Stearate Ointment 
(Unguentum Zinci Stearas) 



This contains 50% of zinc stearate. 

[ic Acetate 
nci Acetas) 

This is used for injections and douches, in gonorrhoea. 

ac Chloride 
inci Chloridum) 

This is a white powder which is moulded into pencils* 



ASTRINGENTS 567 

It absorbs moisture from the air. It is used to destroy 
tissues (caustic action). It is an ingredient of many 
^^ cancer cures," and is applied as an ointme7:^t to destroy 
the cancerous tissue. 

Solution of Zinc Chloride 
(Liquor Zinci Chloridum) 

This contains about 36% of zinc chloride, and is used as a 
disinfectant for sinks and toilets. 

Burnett's disinfecting fluid 

This contains about 13-30 c.c. of zinc chloride. 

Zinc Iodide 0.06-0.12 gm. * grs. i-ii 

(Zinc lodidum) 

It is used locally as a caustic and to increase the growth of 
tissue. 

Zinc Valerate 0.03-0.12 gm. grs. i-ii 

(Zinci Valeras) 

Zinc Bromide 0.03-0.12 gm. grs. i-ii 

(Zinci Bromidum) 

This is used to lessen nervousness and the twitchings of 
chorea and epilepsy. 

COPPER (CUPRUM) 

Copper is a metal, many salts of which are occasionally 
used as drugs. 

Preparations 

Copper Sulphate (blue vitriol or blue stone) 
(Cupri Sulphas) as an astringent 0.015-0.12 gm. grs. i-ii 
as an emetic 0.3 -0.6 gm. grs. v-x 

It is used principally to contract the granulations which 
form in the eyelids in trachoma, an infectious disease of the 
eyelids. 

It is also used to produce vomiting, as an astringent, 
and occasionally to destroy tissue (escharotic action). 

Copper Citrate (not official) 
(Cupricum Citricum) 



568 ^lATERIA MEDICA 

This contains about 35% of copper. It is used as an 
astringent in 5-10% ointments. 



BISMUTH (BISMUTHUM) 

Bismuth is a crystalline metal. ]\Iany of its insoluble 

salts are used as medicines. 



Poisonous Effects 

Bismuth poisoning occasionally results when it is used for 
a long time; especially in the form of dressings. Such appli- 
cations are more apt to cause poisonous symptoms than its 
internal administration. 

Symptoms 

The following symptoms, which resemble those of mercury 
poisonmg appear very slowly : 

1. Profuse flow of sahva. 

2. Swelling of the gmns, tongue and throat, often with 
destruction of the soft palate, and other portions of the 
mucous membrane of the mouth. 

3. Vomiting and diarrhoea. 

4. Albumin in the urine. 

The s^Tiiptoms usually disappear when the dressings are 
removed. 

Uses 

Bismuth salts are used as dusting powders on the skin, as 
astringents, as antiseptics and to promote healing of ulcers, 
and sinuses. 

They are principally used to coat, protect and heal ulcers 
of the stomach, and as an astringent to check diarrhoea. 
They are often used to lessen nausea and vomiting. The 
stools usually turn black when bismuth is being given. This 
is due to the formation of bismuth sulphide. 

Large quantities of bismuth pastes are often given to coat 
the mucous membranes of the oesophagus, stomach and 
intestines so as to enable an X-ray picture to be taken. The 



ASTRINGENTS 569 

bismuth is not penetrated by the X-rays, so that the organ 
containing the bismuth produces a dark shadow on the 
picture. 

Preparations 

Bismuth Subnitrate 0.3-2.0 gms. grs. v-xxx 

(Bismuthi Subnitras) 

Bismuth Subcarbonate 0.3-2.0 gms. grs. v-xxx 

(Bismuthi Subcarbonas) 

Bismuth and Ammonium Citrate 0.12-0.3 gm. grs. ii-v 
(Bismuthi et Ammonii Citras) 

This is more injurious to the tissues than the other prepara- 
tions. 

Bismuth Subgallate 0.3-1.3 gm. grs. v-xx 

(Bismuthi Subgallas) 
(Dermatol) 

New and Non-official Preparations 

Bismuth Beta Naphtholate 1.0-4.0 gms. grs. xv-5i 

(Bismuthi Beta Naphtholas) 

This is used to check diarrhoea and as an intestinal anti- 
septic. 

Bismuth Subcarbonate Preparations 

Cremo Bismuth 4.0-16.0 c.c. 5i-iv 

(Mistura Bismuthi Subcarbonatis Hydrati) 

Lac Bismo 4.0-16.0 c.c. 5i-iv 

(Mistura Bismuthi) 

This is a mixture of bismuth hydroxide and bismuth 
subcarbonate. 

Bismuth Subgallate Preparations 

Airol (Bismuth Oxyiodogallate) 
(Bismuthi lodosubgallas) 

This is a combination of bismuth oxyiodide and gallic 
acid. It liberates iodine and is used as a local appHcation 
to wounds, in 10% solutions in glycerin or in a 10 or 20% 
ointment. 

Bismal 0.12-0.3 gm. grs. ii-iv 

(Bismuthi Methylen Digallas) 



570 MATERIA MEDICA 

Tannismuth 0.3-0.6 gm. grs. v-x 

(Bismuthi Bitannas) ^ 

This contains about 17 to 21% of bismuth. 

Bismon (Colloidal Bismuth Oxide) 0.5 gm. grs. viii 

This is an albuminous solution containing 20% of bismutL 

Bismuth and Iron Citrate 0.3-0.6 gm. grs. v-x 

(Bismuthi et Ferri Citras) 

This is used for anaemia with gastric disturbances. 

Crurin Purum 

(Quinolin Bismuth Sulphocyanate) 

This is used principally as an antiseptic in gonorrhoea and 
in ulcers of the leg in 1-200 solutions. 

Bismuthal 

This is a mixture of pepsin, hydrochloric acid, and bis- 
muth. 

Xeroform 1.0-3.0 gms. grs. xv-xlv 

(Bismuthi Tribromiphenolas) 

This is used principally as an antiseptic in ulcers of the 
leg, eczema, and as an intestinal antiseptic. 

CERIUM OXALATE 

Ceriimi oxalate is a salt of cerium, a crystalline metal, 
which resembles bismuth. 

It is used to check vomiting; in pregnancy, sea-sickness, 
and in other conditions. Its mode of action is unknown. 

Preparations 

Cerium Oxalate 0.12-0.6 gm^ grs. ii-x 

(Cerii Oxalas) 

BARIUM 

Barium is a crystalhne metal. The only salt commonly 
used in medicine is barium sulphate. A paste made with 
this salt is used to coat the stomach and intestines for taking 
X-ray pictures. 



ASTRINGENTS 571 

ALKALINE ASTRINGENTS 

POTASSIUM CHLORATE 

Potassium chlorate is a white crystalline powder having a 
cool salty taste. Its effects are due to the chlorate ion 
of the salt. 

ACTION 

Applied to the skin or mucous membranes, potassium 
chlorate contracts the tissues and acts as an astringent. 
It is therefore used to relieve inflammation of ulcerated 
surfaces or mucous membranes. It is frequently used as a 
gargle for sore throat and for ulcerations of the mouth fol- 
lowing mercury poisoning. When absorbed, it increases the 
flow of urine, but it is seldom given for this effect, because 
of its poisonous action. 

Potassium Chlorate Poisoning 

This condition usually results when a potassium chlorate 
gargle is swallowed by mistake. The symptoms are due 
to the formation in the blood of methaemoglobin, a form of 
haemoglobin which does not combine with oxygen; and the 
red corpuscles are then unable to carry oxygen to the tissues. 
At the same time potassium chlorate injures the kidneys, 
producing symptoms of nephritis. 

Symptoms 

1. Abdominal pain. 

2. Profuse vomiting and diarrhoea (the vomited matter 
contains bile or blood) . 

3. Scanty urine, which may contain haemoglobin and 
methaemoglobin (this gives the urine a transparent red 
color) o 

4. Jaundice, with small haemorrhages into the skin. 

5. Cyanosis. 

6. Muscular twitchings, convulsions. 

7. Coma, collapse. 



572 MATERIA MEDICA 

Treatment 

The treatment consists in washing out the stomach and 
giving heart stimulants. The condition is best reheved, 
however, by removing a quantity of blood from a vein 
(and thereby a quantity of the methaemoglobin) and re- 
placing it by an intravenous infusion of normal salt solu- 
tion. 

Preparations 

Potassium Chlorate 0.06-0.3 gm. grs. i-v 

(Potassii Chloras) 

It is used in 4-6% solutions as a gargle. 

Troches of Potassium Chlorate. Each contains 0.3 gm. (grs. v) 
(Trochisci Potassii Chloratis) 

Sodium Chlorate 0.06-0.3 gm. gr. i-v 

This has the same action as potassium chlorate. 

VEGETABLE OR ORGANIC ASTRINGENTS 

Vegetable astringents are vegetable substances whose 
principal action is to contract the tissues and lessen the 
secretion of the mucous membranes. These effects are due 
to an organic acid, tannic acid, which all these substances 
contain. 

TANNIC ACID OR TANNIN 

Tannic acid is an organic acid which is found in a great 
many vegetable substances. It is obtained from powdered 
nutgall or oak gall. This is a vegetable growth produced in 
the bark of an oak tree; the Quercus lusitannica, dyers' oak, 
or gall oak. The growth results when a species of fly (the 
Cynips gallae tinctoriae) punctures the bark and deposits its 
eggs at the site of puncture. 

There are various forms of tannic acid, depending on the 
plant from which it is derived; for example, gallotannic acid, 
from nutgall, kinotannic acid, from kino, catechutannic acid 
from catechu, etc. 



ASTRINGENTS 573 

Tannic acid is very closely related to gallic acid, which is 
tannic acid combined with water. 



ACTION 

The action of tannic acid is due to the coagulation of the 
proteins of the cells with which it comes in contact. 

Local action; Applied to the skin, to a wounded surface or 
to an ulcer, tannic acid contracts the tissues by coagulating 
or hardening their cells. If applied to a bleeding point, it 
stops the bleeding by coagulating the proteins of the 
blood. 

On mucous membranes: It checks the secretion, by con- 
tracting the cells. 

Internal Action 

In the mouth ; It has a harsh bitter taste, and makes the 
mouth feel dry by contracting the mucous membrane. 

In the stomach: It precipitates the protein of the food 
which is then not readily digested. 

In the intestines: It contracts the mucous membrane, 
thereby checking its secretions and making it less susceptible 
to impulses that start peristalsis, which is then lessened, 
and the bowels are constipated. 

Action after Absorption 

Part of the tannic acid is changed in the intestine to gallic 
acid and to a salt, a tannate, which is absorbed into the 
blood, but which produces no effects on the tissues or organs 
of the body. 

Excretion 

Most of the tannic acid is destroyed in the body, but 
a very small amount is eliminated in the stools and urine as 
tannic acid, gallic acid or pyrogallic acid. 

Poisonous Effects 
Tannic acid is not a strong poison. ' Large doses, by the 



574 MATERIA MEDICA 

destruction of many of the cells of the mucous membrane 
of the alimentary tract, often cause nausea, vomiting and 
diarrhoea. 

Uses 

Tannic acid preparations are used principally: 

1. To check excessive secretion of the alimentary tract, 
as in diarrhoea. 

2. To check excessive secretion and swelling of mucous 
membranes, as in the diseased condition of the mouth in 
mercury poisoning. 

3. To prevent bed sores by hardening the skin. 

4. As an antidote to various metallic and alkaloid poisons. 

5. It is often given as an astringent irrigation in the colon 
and vagina. 

Administration 

For a local effect it should be given in the form of an oint- 
ment or a lotion. 

For its effect in the stomach, it is best given in powder 
form. 

For its effect in the intestines, it is best given in pill form.. 

Preparations 

Tannic Acid 0.12-0.6 gm. grs. ii-x 

(Acidum Tannicum) 

Troches of Tannic Acid 0.06-gm. gr. i 

(Trochisci Acidi Tannici) 

For Local Use : 
Glycerite of Tannic Acid 
(Glyceritum Acidi Tannici) 
This contains 20% of tannic acid. 

Tannic Acid Ointment 
(Unguentum Acidi Tannici) 
This contains 20% of tannic acid. 

Styptic Collodion 
(Collodium Stypticum) 
This contains 20% of tannic acid. 



ASTRINGENTS 575 

New and Non-official Preparations 

The following preparations are not so apt to cause nausea 
and vomiting and are milder in their action. 

Tannalbin 0.3-1.0 gm. grs. v-xv 

Tannin Albuminate 
(Albuminas Tannas) 

This is a compound of tannic acid and albumin and is used 
to check diarrhoea. It is not dissolved in the stomach and 
acts only in the intestines. 

Tannigen 0.2-0.6 gm. grs. iii-x 

Tannyl Acetate 

(Acidum Tannicum Diacetylicum) 

This is used to check diarrhoea and acts in the intestine 
when it comes in contact with the intestinal juice. 

Tannoform 0.25-0.5 gm. grs. iv-viii 

(Tanninf ormald ehydum) 

This is a compound of gallotannic acid with formaldehyde. 
It is an astringent and antiseptic and is used to check di- 
arrhoea. 

It is also used locally as a powder in 25% to 50% solutions 
or as a 10% ointment for eczema, profuse sweating, etc. 

Tannopin or Tannon 0.3-0.5 gm. grs. v-viii 

Hexamethylene Tetramine Tannin 

This is used as an astringent and as an antiseptic in the 
intestines m chronic colitis, tuberculous enteritis, etc. 

Protan 1.0-2.0 gms. grs. xv-xxx q. 2 h. 

Tannin Nucleo Proteid 

For children, 0.3-0.6 gm. grs. v-x q. h. 
This is a compound of casein and tannic acid, containing 
50% of tannic acid. It is used to check diarrhoea. 

Tannacol 1.0-2.0 gms. grs. xv-xxx 

Gelatine Tannate 

This is used to check diarrhoea. 



576 MATERIA MEDICA 

GALLIC ACID 

Gallic acid is an organic acid which is usually made from 
tannic acid by its combination with water. 

ACTION 

GaUic acid does not coagulate albumins, and it has a 
milder action than tannic acid. It is more readily absorbed 
into the blood, and is only used to check excessive secretion 
of sweat, of bronchial mucus and to check bleeding from the 
lungs or kidneys, but it is not very effective. 

Preparations 

Gallic Acid 0.3-2.0 gms. grs. v-xxx 

(Acidum Gallicum) 

GALLOGEN (not official) 

Gallogen, ellagic or benzoaric acid is an acid obtained 
from the pods of the divi divi plant or Coesalpina coraria. 
It checks diarrhoea and contracts mucous membrane. 
It is given in doses of 0.6-1.0 gm. (grs. v-xv) 

VEGETABLE SUBSTANCES CONTAINING TANNIC OR 
GALLIC ACIDS 

GALLA (NUTGALL) 

Galla or nutgall is a growth which forms on the bark of 
the Quercus infectoria, or gall oak tree, by the punctures 
and the deposited eggs of a species of fly (Cynips tinctoria). 
Before the larvae are formed from the ova, the galls contain 
about 50% of tannic acid and smaller quantities of gallic 
acid. 

ACTION 

Nutgall contracts the tissues and checks the secretion of 
mucous membranes because of the tannic acid which it con- 
tains. It is little used except in the form of an ointment, as 
a local application for haemorrhoids. 



ASTRINGENTS 577 

Preparations 

Tincture of NutgaU 2.0-12.0 gms. grs. xxx-5iii 

(Tinctura Gallae) 

Nutgall Ointment 
(Unguentum Gallae) 

Gall and Opium Ointment (not official) 
(Unguentum Gallae cum Opii) 

This contains 7^% of opium. 

GAMBIR 

Gambir or pale catechu is an extract made from the leaves 
and twigs of Ouraparia gambir, an East Indian shrub. It is 
used as a powerful astringent; contracting the tissues and 
checking the secretions of mucous membranes, because of 
the tannic acids which it contains. 

Preparations 

Gambir 1.0 gm. grs. xv 

Compound Tincture of Gambir 4.0 c.c. 3i 

(Tinctura Gambir Composita) 

Troches of Gambir, each containing 0.06 gm. gr. i 
(Trochisci Gambir) 

This contains catechu, kino, krameria, cinnamon and nut- 
meg. 

KRAMERIA (RHATANY) 

Krameria is obtained from the roots of Krameria triandra, 
and of Krameria Ixima, para rhatany, and peruvian rhatany, 
two South American shrubs. 

They are powerful astringents, contracting the tissues and 
checking the secretions, because of the tannic acid which they 
contain. 

Preparations 
Tincture of Krameria 2.0-8.0 c.c. S^-ii 

(Tinctura Krameriae) 



578 MATERIA MEDICA 



KINO 



Kino is the dried juice of the Pterocarpus marsupium, an i 

East Indian tree. [ 

It is a strong astringent, contracting tissues and checking 

the secretions of the mucous membranes, because of the ; 

tannic acid which it contains. \ 

Preparations 

Tincture of Kino 2.0-8.0 c.c. S^-ii 

(Tinctura Kino) 

HAMAMELIS (WITCH HAZEL) \ 

Hamamehs or witch hazel, is obtained from the leaves, ] 

bark and twigs of Hamamelis virginiana, an American plant, i 

It contains tannic acid and a volatile oil. ] 

It contracts the tissues and checks the secretions of mu- i 

cous membranes. It is used to check bleeding and to lessen | 

inflammations. ; 

Preparations i 

Fluidextract of Witch Hazel Leaves 2.0 c.c. m. xxx j 

(Fluidextractum Hamamelis Foliorum) i 

Extract of Witch Hazel 8.0 c.c. 5ii j 

(Aqua Hamamelis) 1 

] 
This is a colorless alcoholic fluid made by distilhng the 
leaves and twigs of witch hazel. It contains very little 

tannic acid and a volatile oil. I 

j 

RUBUS (BLACKBERRY) j 

Rubus or blackberry is the bark of the roots of various ! 

species of the blackberry plant, such as Rubus villosus, j 
Rubus canadensis and Rubus trivialis. 

It is used as an astringent to contract the tissues and check 

the secretions of mucous membranes, because of the tannic ; 

acid which it contains. i 



ASTRINGENTS 579 

Preparations 

Fluidextract of Blackberry 2.0-8.0 c.c. S^-ii 

(Fluidextractum Rubi) 

Blackberry brandy is a common household remedy used 
to check diarrhoea. 

RHUS GLABRA (SUMACH) 

Rhus glabra is obtained from the fruit of Sumach berries. 
It contains tannic and mallic acids. 

It is used as an astringent gargle, diluted in two parts 
of water, for sore throat and pharyngitis. 

Preparations 

Fluidextract of Rhus Glabra 
(Fluidextractum Rhois Glabrae) 

ROSA GALLICA (RED ROSE PETALS) 

Rosa gallica is made from red rose petals, gathered from 
the unopened buds. 

It is used as a mild astringent and as a flavoring in- 
gredient. 

It usually comes in the form of a fluidextract, a honey, 
a syrup, and a confection, for flavoring purposes. 

For local use, the following preparations are used: 

Rose Water 
(Aqua Rosae) 

Stronger Rose Water 
(Aqua Rosae Fortior) 

Cold Cream or Rose Ointment 
(Unguentum Aqua Rosae) 

CAMELLIA THEA (TEA PLANT) 

Tea leaves contain large amounts of tannic acid. If they 
are boiled for a long time, and the leaves then squeezed out 
the resulting fluid contains large amounts of tannic acid. 



580 MATERIA MEDICA 

Chamomile, jambul, and many of the vegetable sub- 
stances used as bitters, contain large amounts of tannic acid, 
and have, therefore, an astringent action. 

MYRRH (MYRRHA) 

Myrrh is a gum resin obtained from the Commiphera 
Myrrha, an American tree. Its active principle is a resinous 
substance. 

It contracts skin and mucous membranes and is slightly 
disinfectant. It increases the secretions and is said to in- 
crease menstruation. 

It is used principally as an astringent ; in inflammations of 
the gums as in mercury poisoning, and as an ingredient of 
many cathartics. 

Tincture of Myrrh 2.0-4.0 c.c. SH 

(Tinctura Myrrhae) 



CHAPTER XXXII 

ANTISEPTICS 

Antiseptics or disinfectants are drugs which check the 
growth of bacteria (bacteria are very small unicellular micro- 
scopic organisms, many of which cause disease). They 
are divided into two groups: germicides and antiseptics. 

Germicides or disinfectants are drugs which destroy bac- 
teria. Antiseptics are drugs which check the growth of 
bacteria, usually by making the fluid in which they grow 
unfit for them to live in. Deodorants are drugs, most of 
which are also antiseptics, that destroy unpleasant odors. 

The antiseptics, while checking the growth of bacteria, 
are also injurious to the tissue cells. They must there- 
fore be used in solutions so weak that the drug will affect 
only the bacteria, and do little harm to the tissues. Anti- 
septics may be classified according to their practical use 
in the following way: 

(a) Local Antiseptics 

1. Disinfectants for rooms. 

2. Disinfectants for sinks, clothing, excreta, etc. 

3. Antiseptics for the hands. 

4. Antiseptics for the skin. 

5. Antiseptics for wounds, ulcers, sinuses, etc. 

6. Antiseptics for mucous membrane lined cavitieSo 

(b) Antiseptics acting after absorption 

1. Antiseptics acting on the lungs. 

2. Genito-urinary antiseptics. 

581 



582 MATERIA MEDICA 



DISINFECTANTS FOR ROOMS 

FORMALDEHYDE 

Formaldehyde is a gas obtained by oxidizing wood alcohol. 
A solution containing 40% of formaldehyde gas is called 
formalin. 

ACTION 

Antiseptic Action 

Formaldehyde gas vigorously destroys bacteria (germi- 
cide) and checks their grov/th (antiseptic). It also neu- 
tralizes unpleasant odors (deodorant). 

Local action: Applied to the skin or mucous membranes, 
formalin hardens the tissues and checks the growth of bac- 
teria on the surface. 

When formaldehyde gas is inhaled, it causes stinging and 
prickling sensations in the nose, mth a profuse flow of mu- 
cus from the nose, a flow of tears from the eyes, secretion of 
saliva, and excessive coughing, with profuse expectoration. 

Internal Action 

Very small doses of formalin, when given internally, cause 
nausea and vomiting, lessen the digestion of food and make 
the pulse somewhat slower and weaker. 

Poisonous Effects 

Poisoning by large doses of formalin or formaldehyde gas 
occurs occasionally, and produces the following symptoms : 

1 . Nausea and vomiting. 

2. Diarrhoea. 

3. Shortness of breath and cyanosis (due to* contracting 
the red blood cells and the formation of haematin in the 
blood). 

4. Collapse, coma, convulsions and death. 
The best antidote is ammonia water. 



ANTISEPTICS 583 

Uses 

Formaldehyde gas is used principally to fumigate rooms and 
to disinfect clothing. It is generated in the following ways: 

1. By heating a solution of formalin in the room; 150 c.c. 
of formahn are necessary to disinfect a room of 1000 cubic 
feet of space. 

2. By heating paraform, a solid substance which hberates 
formaldehyde gas. There are numerous lamps on the 
market which liberate formaldehyde gas in this way. 

3. By a specially constructed apparatus for generating 
formaldehyde gas. The gas is allowed to enter the room 
through a rubber tube which is inserted in the key-hole. 

When disinfecting with formaldehyde gas, the cracks in 
the door should be stuffed with cotton and the room should 
be kept closed for 24 hours. The unpleasant odor is re- 
moved by sprinkling ammonia water about the room. 

Formalin is used in 1-200 solutions to sterilize instruments. 
There are a number of instrument sterilizers on the market 
which generate formaldehyde gas and sterilize the instru- 
ments in this way. Formalin has also been used as a mouth 
wash and as a douche in 1-500 to 1-1000 solutions. 

It is occasionally used as a preservative for milk and other 
foods. A 4% solution of formalin is used to preserve tissues 
for microscopic examination. 

Preparations 

Formalin 

(Liquor Formaldehydi) 
This contains 37% of formalhyde gas. 

Paraform or Paraformaldehyde 
(Trioxymethylene) 

This is a solid substance which liberates formaldehyde 
gas on heating. It is used locally to destroy warts and also in- 
ternally as an antiseptic. 

There are a number of other preparations which liberate 
formaldehyde gas in the body; they will be described under 
^heir particular use. 



584 MATERIA I^IEDICA 

SULPHUR DIOXIDE 

Sulphur dioxide or sulphurous acid is a gas which is 
formed when sulphur is burned. It is one of the oldest dis- 
infectants in medicine; being used since 1771. It is an ex- 
cellent disinfectant for rooms; but it is apt to injure clothing, 
linens, carpets, etc. 

Uses 

Sulphur dioxide is formed when suiphur candles or sulphur 
masses are burnt in the room. The sulphur should be placed 
in a metal or porcelain dish placed in a basin of water, and 
the sulphur should then be burned. All cracks and key-holes 
in the room should be tightly closed. 

CHLORINE (CHLORUM) 

Chlorine is an element which occurs in the form of a green- 
ish yellow gas. It is obtained from sea salt, and a number 
of its compounds are used as disinfectants. 

Chlorine, bromine, and iodine, are three closely related 
elements called halogens, since they are all obtained from the 
sea; thus; chlorine from sea salt, bromine from sea water, 
and iodine from sea weeds. 

ACTION 

Antiseptic action 

Chlorine gas is one of the most efficient disinfectants 
known; especially when it is used in the presence of moisture. 
The chlorine combines with the hydrogen of the water, thus 
setting oxygen free. The oxygen then destroys the bacteria. 
A 0.3% solution of chlorine will destroy even the spores of 
bacteria in about three hours. Chlorine also removes obnox- 
ious odors very readily (deodorant). 

Action on the Body 

Local action: Concentrated solutions of chlorine gas 
redden the skin and produce bhsters if the solution is pre- 



ANTISEPTICS 585 

vented from evaporating. On mucous membranes it in- 
creases the secretions. 

Internal Action 

In the mouth chlorine usually causes profuse secretion 
of saliva. In the stomach and intestines it increases the 
secretions. Inhalation of chlorine gas usually makes the 
patient cough and increases the secretions of the bronchi. 

Poisonous Effects 
If large quantities of chlorine solutions are swallowed the 
following effects are produced: 

1. Redness and destruction of the tissues around the 
mouth. 

2. Abdominal pain. 

3. Nausea and vomiting. 

4. Collapse (cold moist skin, rapid thready pulse, slow 
and shallow breathing.) 

These symptoms are due to the formation of excessive 
amounts of hydrochloric acid in the stomach. 

If the gas is inhaled, the patient has violent coughing; 
often with bloody expectoration. 

The symptoms should be treated with alkalies, such as 
sodium bicarbonate; for the pain, morphine should be given; 
as well as albumins, milk, or flour to protect the mucous 
membrane of the stomach. 

Uses 

Chlorine is used principally to disinfect stools and urine. 
It is used in the form of chlorinated lime; which liberates 
chlorine gas. It has a special advantage in removing foul 
odors. Concentrated chlorine gas, liberated by a specially 
constructed generator is used to disinfect rooms. It is very 
efficient; but it bleaches various dyed materials. It is pre- 
pared by placing a dish containing equal parts of black oxide 
of manganese and salt in the center of the room. To this 
is added one tablespoonful of strong sulphuric acid diluted 
one third. Enough chlorine gas will thus be formed to 
disinfect the room. 



586 MATERIA MEDICA 

Preparations 
Chlorine water 
(Liquor chlori compositae) 

This is a solution containing 4 parts of chlorine gas to 
1000 c.c. of water. 

It should be freshly prepared, since old preparations may 
contain hydrochloric acid. 

Chlorinated Lime or Bleaching Powder 
(Calx Chlorinata) 

This is a grayish white powder containing 35% of chlorine 
gas when fresh. It is sometimes erroneously called chloride 
of lime. A fresh powder forms a clear solution; otherwise 
the solution becomes turbid. 

Solution of Chlorinated Soda 0.6-1.3 c.c. m. x-xx 

(Liquor Sodae Chlorinatae) 
(Labarracque's or Javelle's Solution) 

This is a solution made from chlorinated lime and sodium 
carbonate. It contains sodium hypochlorite and sodium 
chloride. It liberates about 23/^% of chlorine gas and is 
used for cleaning medicine droppers, douche nozzles and 
other small utensils. It is especially valuable to remove 
stains. It is occasionally given internally in half a tumbler 
of warm milk. 

BROMINE (BROMUM) 

Bromine is a liquid element obtained from sea water. 
Its action is similar to that of chlorine with the following 
differences : 

1. It is more destructive to the tissues. It is occasionally 
used to cauterize infected wounds (escharotic action). 

2. When given internally in the form of bromides it lessens 
the activity of the brain (see Bromides). 

DISINFECTANTS FOR SINKS, CLOTHING, ETC. 

For this purpose formalin is occasionally used in 10% 
fcjolutions. 



ANTISEPTICS 587 

CARBOLIC ACID (PHENOL) 

Carbolic acid or phenol is a crystalline solid substance 
SK hich readily absorbs moisture from the air. It is made 
by distilling coal tar; it dissolves readily in water, alcohol or 
glycerine. 

Antiseptic Action 

Carbolic acid destroys all living tissues (protoplasm). 
In weak solutions (2-5%) it checks the growth of all bacteria 
except their spores. It is the most efficient antiseptic known. 

Action on the Body 

Local action: Concentrated solutions destroy the skin by 
hardening or coagulating the proteins of the cells. This 
forms a white crust which becomes red and shiny. The 
crust falls off in a few days, leaving a light brown area. 
Weak solutions (2-5%) produce a feeling of warmth and 
tingling followed by numbness and contraction of the skin. 
Applied to wounds, carbolic acid causes pain and redness 
with the formation of a white pellicle of coagulated albumin. 

Local applications of carbolic acid solutions, if prevented 
from evaporating, as when applied in the form of a wet 
dressing, often destroy the skin and deeper tissues (gan- 
grene). Gangiene of a finger or other part of the body has 
occasionally resulted from continued use of such wet dress- 
ings. For this reason its use as a wet dressing has been 
given up. On mucous membranes: carbolic acid checks the 
growth of bacteria if applied in weak solutions. 

Strong solutions, if applied for some time, destroy the 
tissues ; and if the area over which it is applied is extensive, 
collapse may result. 

Internal Action 

Carbolic acid is never given internally. When taken with 
suicidal intent it produces effects after absorption (see 
poisonous effects). There are, however, a number of drugs, 
such as salol, which form small amounts of carbolic acid 



588 MATERIA MEDICA 

in the intestines. These then act as antiseptics, checking 
the growth of bacteria in the intestines. In this way they 
lessen the decomposition of the waste products in the intes- 
tines (putrefaction). 

Action after Absorption 

When a small quantity of carbolic acid is absorbed, 
either from wet dressings applied to wounds or when formed 
in the intestine, it occasionally produces the following effects : 

1. It increases the secretion of saliva. 

2. It increases the flow of urine. The urine has a char- 
acteristic smoky dark green color which soon turns brown 
or even black. 

3. Occasionally, the patient becomes somewhat drowsy, 
due to the lessened action of the brain, (depression) . 

4. The breathing becomes somewhat deeper and faster 
and the pulse slower and weaker. 

Excretion 

In cases where a small quantity of carbolic acid is ab- 
sorbed, it is rapidly eliminated by the urine in the form of 
various compounds which give the urine a characteristic 
dark green color. 

Poisonous Effects 

Acute poisoning from carbolic acid is not an infrequent 
occurrence as a result of attempts at suicide, since it is the 
easiest poison to obtain. 

Symptoms 

If a large quantity of carbolic acid is taken, the patient 
becomes unconscious and dies within a few minutes from 
a sudden paralysis of the heart and respiration. This is 
probably due to the sudden destruction of a large area of 
mucous membrane and the resulting collapse. 

If smaller quantities are taken, the following symptoms 
appear in the order of their onset: Some of these symptoms 
also occasionally result from the continued use of wet dress- 
ings. 



ANTISEPTICS " 589 

1. Pain around the mouth and hps, and in the stomach. 
The Hps and mouth are blanched. 

2. Nausea and vomiting, the vomited matter containing 
mucus. 

3. Headache, dizziness, and noises in the ears. 

4. Drowsiness and depression. 

5. Collapse: rapid thready pulse, cold moist skin, the 
pulse falls to 40 or 50 per minute, the breathing becomes 
irregular, often snoring in character. Toward the end, the 
breathing becomes difficult and shallow, sometimes gasping, 
and because of the shallow breathing, the patient becomes 
cyanotic. 

6. Finally, the patient goes into stupor, and coma, and 
may die from paralysis of the respiration, in about one to 
ten hours. 

Occasionally, convulsions occur just before death. A very 
characteristic symptom of carbolic acid poisoning is the 
dark green color of the urine, and the odor of the acid on the 
breath. The fatal dose is usually about 5i-iv. 

Treatment 

1. Wash out the stomach with 20% alcohol. 

2. The following salts are given as antidotes: about Si of 
one of the salts dissolved in a glass of water. 

Magnesium sulphate (Epsom salts). 
Sodium sulphate (Glauber's salts). 
Lime water and milk. 
They form sulphocarbolates; harmless salts of carbolic acid. 

3. Give alcohol in the form of whiskey or brandy, or 
even in 20% solutions. The alcohol neutralizes the car- 
bolic acid; its mode of action is unknown. (A carbolic 
acid burn is readily neutralized, if followed immediately 
by the application of alcohol). The stomach should be 
washed out, however, as the solution is readily absorbed. 

4. Protect the mucous membrane of the mouth and 
oesophagus with albumin water, flaxseed tea or milk. Do not 
give oils or glycerine as they help to absorb the carbolic acid. 

5. The collapse is treated with heart stimulants such as 
caffeine, strychnine, atropine, etc., and the patient should 
be kept warm. 



590 MATERIA MEDICA 

Uses 

Carbolic acid was the first substance used as an antiseptic. 
It was formerly sprayed in operating rooms to disinfect the 
air, since most infections were supposed to come from the 
air. Later knowledge of the nature of infections has proven 
the worthlessness of this use. At the present time carbolic 
acid is used : 

1. To disinfect sinks, toilets, sputum cups, clothing, etc., 
in 2-5% solutions. The articles must be soaked in carbolic 
acid for a half to several hours. 

2. To disinfect the sick room by washing the walls and 
furniture. The fumes are often inhaled from such use and 
cause slight poisonous symptoms. 

3. It is occasionally given internall}^ to check vomiting, 
and as an intestinal antiseptic to check fermentation in the 
intestines. 

Preparations 

Carbolic Acid: For internal use 0.03-0.2 gm. grs. J-iii 
(Phenol) 

This comes in crystals which readily take up water (hy- 
groscopic). It is used principally for its destructive action 
on tissues (corrosive action). 

Liquid Carbolic Acid: For internal use 0.06-0.2 c.c. m. i-iii 
(Phenol Liquefactum) 

This contains 90% of carbolic acid. 

Glycerite of Phenol 0.12-0.3 c.c. m. ii-v 

(Glyceritum Phenolis) 

This contains 20% of phenol dissolved in glycerine. 

Carbolic Acid Ointment 
(Unguentum Phenolis) 

This contains 5% cf carbolic acid. 

As an antiseptic carbolic acid is used in 2-5% solutions. 

Carbolic Acid Derivatives 
Cresols 
There are a number of oily substances which are exteu* 



ANTISEPTICS • 591 

sively used as antiseptics; and are chemically closely related 
to carbolic acid. 

They are oily solutions, which do not dissolve readily in 
water and are used as emulsions or in soapy solutions. The 
antiseptic, physiological and poisonous actions of all of them 
are like that of carbolic acid. 

Preparations 

Cresol 0.06 c.c. m. i 

This is a mixture of all the cresols. 

Compound Solution of Cresol 
(Liquor Cresolis Compositus) 

This is a 50% solution of cresol in soap solution. It is 
used in dilute solutions as a disinfectant. 

New and Non-official Preparations 
Tricresol 

This is a mixture of all the three cresols. 

Kresamine 
(Ethylenediamine Tricresol) 

This contains 25% of tricresol and is used as an antiseptic 
like phenol and as an ointment for skin diseases. 

Creolin 

This is an emulsion of cresol. It is used in 1-5% solutions 
to disinfect sinks, excreta, toilets, etc. It is also used in i 
to 1% solutions for vaginal douches, and for bladder irriga- 
tions. Creolin solutions must be made up with warm water o 

Lysol 

This is a 50% solution of cresols dissolved in soap. It 
forms a frothy solution in water and is used for douches and 
other irrigations in | to 1% solutions. 

Lysoform 

This is a combination of lysol and formaldehyde which 
is used as a disinfectant in 5 to 10% solutions. 



592 ' MATERIA MEDICA 

Solveol 
Solutol 

These are solutions of cresols which have been made 
soluble by the addition of salts. 



OTHER ANTISEPTICS FOR CLOTHING AND EXCRETA 

ZINC SULPHATE 

This acts as a disinfectant by precipitating the proteins 
of the bacteria. For this purpose the following solution is 
used: 

Zinc sulphate 60.0 gms. Bii 

Sodium chloride 120.0 gms. 5iv 

These salts are dissolved in one gallon of water, and the 
clothes are soaked in this solution for 4-6 hours. 

Zinc chloride is occasionally used as a disinfectant, but it 
is not very rehable and is therefore not frequently used. 

IRON SULPHATE 

This acts as an antiseptic by precipitating the proteins of 
the bacteria. It acts more readily when the bacteria occur 
together with organic matter, such as pus or blood. It is 
used principally to disinfect the stools, using an equal part 
of the solution. 

ANTISEPTICS USED TO DISINFECT THE HANDS 

The following antiseptics are used principally to disinfect 
the hands of the surgeon or nurse when performing or assist- 
ing at an operation, or when dressing wounds. To obtain 
the maximum antiseptic action, the hands should be kept in 
the solution for about five to fifteen minutes. 

Bichloride of Mercury or Corrosive Sublimate 
(Hydrargjrri Chloridum Corrosivum) 

This is used as an antiseptic in solutions of 1-10,000 to 



ANTISEPTICS 593 

1-1000. Continued use of bichloride is apt to be injurious 
to the skin, causing redness and itchinoj. The solution should 
always be fresh, as the bichloride combines with the bacteria 
so that old solutions become inactive. It cannot be used to 
disinfect instruments as it turns them black (corrodes). 

Mercuric Cyanide 
(Hydrargyri Cyanidum) 

This is used in solutions of 1-4000 to 1-2000 Uke bichloride, 
but it does not corrode instruments and does not injure the 
skin. 

Mercury Oxycyanide 
(Hydrargyri Oxycyanidum) 

This is used like bichloride of mercury. It has a greater 
antiseptic power, is less injurious to the tissues, and does not 
corrode instruments. It is used in 1-5000 solutions. 

Sublamine 

(Mercuric Sulphate Ethylendiamine) 

This is similar to calomel. It is used in solutions of 1-1000 
to disinfect the hands, and for irrigations. It is also given 
in 3-4% solutions intramuscularly for syphihs. 

Alcohol 

This is used in 50-70% solutions as a very efficient anti- 
septic for the hands. Stronger solutions are not as active 
because they harden the capsules of the bacteria and do not 
penetrate the bacteria themselves. 

'Time and Soda" 

A very common method of disinfecting the hands is by 
rubbing chlorinated lime and sodium carbonate together in 
the hands. Chlorine gas is hberated in this way, which dis- 
infects the hands. 



594 MATERIA MEDICA 

ANTISEPTICS USED TO DISINFECT THE SKIN 

IODINE (lODUM) 

Iodine is a non-metallic element obtained from the ashes 
of sea weeds. Iodine itself is not used in medicine, but 
various solutions and compounds of it are frequently em- 
ployed. 

Antiseptic Action 

Iodine checks the growth of bacteria, having a marked 
disinfectant action. It has been used very extensively for the 
last few years to disinfect the skin in preparation for opera- 
tions. It is of especial value for this purpose since it also 
contracts and hardens the skin so that bacteria cannot be 
carried from the skin to the deeper tissues of the wound. 
It should not be applied in a concentrated solution or when 
the skin is moist, as it is then apt to cause blisters or even 
to destroy the deeper tissues. 

Action on the Body 

Local action: Iodine stains the skin a dark brown color 
and makes it red and warm. Strong solutions cause blis- 
ters and may even destroy the skin. It is also slightly ab- 
sorbed from the skin. 

On mucous membranes : It produces redness, smarting and 
increases the secretions. 

Internal Action 

When taken internally, it causes nausea and occasion- 
ally vomiting and diarrhoea. It is readily absorbed from the 
stomach in a few minutes. 

Action after Absorption 

The iodine combines in the blood with the sodium or potas- 
sium salts; thus forming iodides. The effects then produced 
are like those of the iodides. (See page 510.) They increase 
the secretion of all the secretory glands, such as the saliva, 
the mucous from the nose and bronchi. They also increase 



ANTISEPTICS 595 

the absorption of newly formed tissues (they are often given 
to reduce enlarged lymph nodes) . At the same time, by in- 
creasing the secretion of the thyroid gland, the pulse be- 
comes more rapid and the patient becomes quite nervous. 

Excretion 

Iodine is eliminated from the body in a few minutes; by 
all the secretions as well as by the kidneys. 

Poisonous Effects 

Acute poisoning from iodine occurs very rarely; usually 
from the injection of iodine into cysts in order to obliterate 
them, and occasionally from iodine taken with suicidal intent. 

Symptoms 

1. Nausea and continuous vomiting. The vomited matter 
contains iodine which turns blue if starch is also present. 

2. Diarrhoea. 

3. Cyanosis. 

4. Collapse, rapid thready pulse, cold moist skin, slow 
shallow breathing and dilated pupils. Death usually occurs 
in a few days. 

Treatment 

Give boiled starch as an antidote. Protect the mucous 
membrane with albumin water, milk or other protecting 
drinks; treat the collapse with heart stimulants; such as 
caffeine, atropine, strychnine, etc. 

Chronic Poisoning *^ lodism " 

Continued use of iodine often causes the following symp- 
toms : 

1. Skin eruptions, beginning at the site of application; 
consisting of areas of redness. 

2. Increased secretion of mucous from the nose and 
bronchi. 

3. Rapid pulse. 

4. Nervousness and tremors of the fingers. 



596 MATERIA MEDICA 

The symptoms usually disappear when the iodine applica- 
tions are stopped. 

Preparations 

Tincture of Iodine 0.06-0.3 c.c. m. i-v 

(Tinctura lodi) 

This contains 7% of iodine and 5% of potassium iodide 
in alcohol. 

Compound Iodine Solution 0.2-0.8 c.c. m. iii-xii 

(Liquor lodi Compositus) 
(LugoPs Solution) 

This contains 5% of iodine dissolved in 10% of potassium 
iodide solution. 

Iodine Ointment 
(Unguentum lodi) 

This contains 4% of iodine. 

Sulphur Iodide 
(Sulphuris lodidum) 

This is a mixture of iodine and sulphur. 

Losophan (Not official) 

This is a preparation containing 78% of iodine. It is 
used as a powder or in 10-20% solutions. 

SULPHUR 

Sulphur is an element which occurs in the form of a yellow 
powder. It is found in volcanoes and also as compounds of 
various metals forming sulphides (a sulphide is a compound 
of sulphur with another element or with a metal). The 
action of sulphur is due to the sulphides which it forms in the 
body. 

ACTION 

Local action: Applied to the skin it shghtly checks the 
growth of bacteria and destroys parasites (parasiticide). 
It stains silver objects black, by forming silver sulphide. 



ANTISEPTICS 597 

Internal Action 

When taken internally, the sulphides which it forms in the 
intestines increase the secretions ; producing mild movements 
of the bowels. It is eliminated from the body as sulphides 
by the expired air; to which it gives a very foul odor, and 
also by the stools. 

Poisonous Effects 

Continued use of sulphur often causes anaemia, great 
wasting and tremors of the muscles. 

Preparations 

Sulphur Ointment 
(Unguentum Sulphuris) 

This contains 15% of sublimed sulphur with benzoin and 
lard. 

Liver of Sulphur 
(Potassa Sulphurata) 

This is a preparation of sulphur which is often used in 
ointments and baths in doses of si-vi cf sulphur to a gallon 
of water. This substance is very destructive to tissues 
(corrosive) . 

Thilanin (Not official) 

This is a mixture of lanolin and sulphur containing about 
5% of sulphur. For other preparations of sulphur used as 
cathartics see page 100. 

ICHTHYOL (Not official) 

Ichthyol is a substance obtained from a peculiar bitumi- 
nous mineral found in the Tyrol. It is formed by the deposits 
of fossil fish and contains about 10% of sulphur. 

ACTION 

Applied to the skin ichthyol is slightly antiseptic and 
cauf^es redness. When given internally it acts as an antisep- 



598 MATERIA MEDICA 

tic in the intestines. In large doses it is apt to cause slight 
nausea and vomiting. The same effects occasionally result 
when it is absorbed from the skin. 

Ichthyol is used as an antiseptic and mild irritant in 
various skin affections. 



Preparations 

Ichthyol 0.2-2.0 c.c. m. iii-xxx 

(Ammonii Ichthyosulphonas) 

This is a reddish brown substance which dissolves readily 
in water. It is used in the form of watery solutions or oint- 
ments in from 1-20% solutions. 

Sodium Ichthyol 

(Sodii Ichthyosulphonas) 

Calcium Ichthyol 
(Calcii Ichthyosulphonas) 

Ichthargan 

(Argenti Ichthyosulphonas) 

This contains 30% of metallic silver and 15% of sulphur. 
It combines the action of both. 

Ferrichthyol 1.0-2.0 gms. grs. xv-xxx 

Ichthalbin 0.6-1.3 gms. grs. x-xx 

(Ichthyol Albuminate) 

Ichthoform 0.6-2.0 gms. grs. x-xxx 

(Ichthyol Formaldehyde) 

This is given in gruel or cocoa as an intestinal antiseptic. 
It is also used to disinfect rooms, for irrigations and in 
douches. 



THIOL (THIOLUM) (Not official) ' 

Thiol is an artificial substance formed by the action of 
sulphur on the tar obtained from broT^Ti coal. Its action is 
like that of ichthyol. It is used in the treatment of burns. 



ANTISEPTICS 599 

Preparations 

Dry Thiol 
(Thiol Siccum) 

This contains 8% of sulphur and is used as a dusting pow- 
der on wounds. 

Liquid Thiol 
(Thiol Liquidum) 

This contains about 2% of sulphur and is used in various 
skin diseases. 

CTumTnil Venale) } T^'^^''°' Ammonmm 

These are artificial preparations made from the same 
mineral as ichthyol. They act like ichthyol and are used 
in solutions of from 5-20%. 

RESORCIN 

Eesorcin or resorcinol is a chemical substance made frorii 
carbolic acid. 

ACTION 

The action of resorcin is like that of carbolic acid. 
Local iction: Applied to the skin it checks the growth of 
bacteria; acting as an antiseptic and disinfectant. 

When given internally it produces the following effects : 

1. It checks the growth of bacteria in the stomach and 
intestines. 

2. It reduces temperature, and increases perspiration. 

3. It makes the pulse slower. 

Overdoses of resorcin produce the same poisonous effects 
that result from carbolic acid poisoning. (See page 588.) 

Uses 

Resorcin is used principally as an antiseptic in skin dis- 
eases, such as dandruff, baldness, etc. It is occasionally 
used as an intestinal antiseptic and to reduce temperature. 



600 MATERIA MEDICA 

Preparations 

Resorcinol 0.3-0.6 gms. grs. v-x 

(M etadioxy b enzol) 

Externally this is used in 5-10% solutions. 

Euresol (Not official) 
(Resorcin Monacetate) 

This acts like resorcin and is especially valuable in dan- 
druff and baldness. 

Pyrocatechin and Hydroquinone are the derivatives of car- 
bolic acid which are rarely used in medicine. 

PYROGALLOL 

Pyrogallol or pyrogallic acid is a light crystalline substance 
made by heating galHc acid. 

ACTION 

The action of pyrogallol is similar to that of carbolic a^jid. 

Applied to the skin or mucous membranes it checks the 
growth of bacteria, acting as an antiseptic; it destroys par- 
asites and produces redness of the skin. It usually stains the 
skin or clothing a dark brown color. 

Pyrogallol is occasionally absorbed from the skin and pro- 
duces poisonous symptoms which resemble those of carboHc 
acid poisoning. (See page 587.) 

Preparations 

P3rrogallol 
(Pyrogallic Acid) 

This is used in the form of 5-20% ointments. 

TAR (PIX LIQUIDA) 

Tar is a black, semi-solid, sticky substance ot* a pecuKar 
characteristic odor and taste. It is an oleoresin, obtained 
by the destructive distillation of the wood of various species 
of the pine tree, especially the Pinus palustris or the pine 
tree of North Carohna. (Destructive distillation is a process of 



ANTISEPTICS 601 

decomposition by heating. Some of the decomposed prod- 
ucts are vapors, and become fluid or semisoKd when passed 
into a cold receptacle.) 

When tar is distilled, it forms the oil of tar, an oily Hquid, 
and a solid black residue called pitch. 

Tar consists of a number of substances; the following are 
the most important ones: creosote, pyroligneous acid, wood 
alcohol, and a number of other compounds. 

ACTION 

Local action: Tar is used principally as an antiseptic and 
irritant in skin diseases. It usually causes considerable in- 
flammation. When the skin becomes severely inflamed, the 
fact should be reported to the physician. Tar should be 
applied with great care to the face and parts of the body 
where the skin is tender. 

Internally, it is principally used as a stimulating expecto- 
rant, especially in chronic bronchitis. It is occasionally used 
to destroy intestinal worms, and as an intestinal antiseptic. 

Preparations 
Oil of Tar 0.06-0.3 c.c. m. i-v 

(Oleum Picis Liquidae) 

Syrup of Tar 4.0-12.0 c.c. 3i-iii 

(Syrupus Picis Liquidae) 

This contains 7J% of tar. 

Tar Ointment 
(Unguentum Picis Liquidae) 

This contains 50% of tar. 

OIL OF CADE 

This is a substance made by destructive distillation of 
Juniper wood. It is used as an antiseptic and irritant in skin 
diseases. 

New and Non-official Antiseptics 
Antiformin 

This is a strongly alkaline solution of sodium hj'-pochlorite. 



602 MATERIA MEDICA 

It rapidly dissolves the bodies of all bacteria, except the 
tubercle bacilli. It dissolves all secretions such as spi^tum 
and also destroys unpleasant odors. It is therefore a dis- 
infectant, antiseptic and deodorant. It is said to be a 
stronger disinfectant than carbolic acid. It is also used in 
testing the sputum and other secretions, for tubercle bacilli. 
Antiformin is used externally in 2-10% solutions, and as a 
spray in 1-1000 solutions. 

Anthrasol 

This is a colorless coal tar which has been freed from pitch, 
coloring matter and other substances and is then mixed with 
juniper tar. It is used as an antiseptic for the skin, to 
destroy parasites and to soothe the skin. It is usually given 
in ointments of 5-30% in various skin diseases. 

Afridol 

This is a compound of mercury used to disinfect the 
hands, as a surgical antiseptic, and for various skin diseases. 
It usually comes in the form of a soap containing about 4% 
of the drug. 

Chinosol 

Chinosol or oxyquinoline sulphate is an artificial chemical 
substance which comes in the form of a yellow powder. It 
is used as an antiseptic for the skin, as a nasal spray, as a 
gargle and as a douche in 1-5000 to 1-1000 solutions. 

Alumnol 

(Alumini Naphtholsulphonas) 

This is used in K-1% solutions as a surgical antiseptic, 
as a gargle and for douches. 

Phenoco 

This is a mixture of coal tar creosote and other coal tar 
derivatives in soap solution. It is used as a surgical antisep- 
tic in 1-5% solutions. 

Veroform 

This is a liquid obtained by dissolving formaldehyde gas 
in a solution of soap. It contains 6-20% formaldehyde gas 
and is used as a surgical antiseptic. 



ANTISEPTICS 603 

ANTISEPTICS USED AS DRESSINGS FOR WOUNDS, 
ULCERS AND SINUSES 

The following antiseptics are the ones most frequently 
used as wet dressings or to irrigate wounds, ulcers and 
sinuses. 

Corrosive Sublimate In 1-10,000 to 1-1000 solutions 

(Bichloride of Mercury) 

Aluminium Acetate Solution 
(Burow^s Solution) 

This is used in | to 2% solutions and is especially valuable 
when it is desired to harden the tissues. 
Boro Salicyl Solution 
(Thiersch Solution) (See page 523). 

DAKIN'S SOLUTION 

Dakin's solution is a specially prepared solution of sodium 
hypochlorite. Sodium hypochlorite has long been used as 
an antiseptic in the form of Labarracque's or Javelle's solu- 
tion. Dakin's solution is prepared in a very special way. 
It must contain exactly 0.45-0.50% of sodium hypochlorite. 
If the percentage of hypochlorite is less the solution is in- 
active; while if it contains more than this percentage the 
solution is very irritating. Furthermore the solution must 
be absolutely neutral in reaction when tested with phenol- 
phthalein otherwise the solution cannot be used. 

ACTION 

Dakin's solution is one of the best antiseptics now in use. 
The employment of this substance according to the method 
devised by Dr. Carrel has practically revolutionized the 
treatment of wounds in the World War. It is about fifteen 
times as strong in its antiseptic power as carbolic acid; yet 
it does not injure the young growing tissue cells and conse- 
quently it does not retard healing as do most other anti- 
septics. 

Dakin's solution produces its effect by liberating free 



604 MATERIA MEDICA 

chlorine which combines with the NH radical of the pro- 
teins in the wound thus forming new compounds called 
chloramins which are the active antiseptic substances. At 
the same time they increase the flow of lymph from the 
wound surfaces. 

Carrel Dakin Method of Treatment of Wounds 

The practical method for using Dakin's solution in the 
treatment of wounds was originally devised by Dr. Alexis 
Carrel of the Rockefeller Institute. 

A fresh, exactly neutral solution is allowed to flow into 
the wound by means of a specially constructed apparatus. 
This apparatus consists of a graduated bottle and a long 
tube which terminates in a number of fine rubber tubes 
with small holes in their sides. These terminal tubes are 
placed in the wound in such a position that the fluid runs 
downward but in contact with every part of the wound, 
after being wrapped around with small pieces of gauze so as 
to keep them in place. Small pieces of gauze are placed be- 
tween the tubes. About every two hours enough fluid is 
allowed to run through the tubes to just fill the wound. 
This intermittent flow is essential because the solution is 
absorbed by the tissues and new fluid is then required. 

Dakin's solution dissolves the clots and dead tissue in the 
wound. It is therefore essential that all the blood vessels 
be tied before the treatment is begun; since the dissolv- 
ing of a clot over an open blood vessel may cause a 
haemorrhage. 

Since Dakin's solution is irritating to the skin the skin 
should be covered with sterile vaseline for protection. If 
the patient complains of pain, it means that the solution is 
flowing under too great pressure or that it has not been 
properly prepared. 

Preparations 
Dakin's Solution (Surgical solution of chlorinated soda) 

This is a specially prepared exactly neutral solution of 
sodium hypochlorite. 



ANTISEPTICS 605 

Chloramine T (Chlorazene) 

This is a sodium compound of a complex organic chlorine 
preparation. It is four times as strong as phenol. It acts 
like Dakin's solution; it is more stable, lasts longer but it 
has not the dissolving power of Dakin's solution. It is used 
in 1 or 2% solutions applied in the same manner as Dakin's 
solution. It is also used as a mouth wash and as an irriga- 
tion for the urethra, bladder and uterus. 

Chloramine B 

This is a sodium preparation of a complex organic chlorine 
preparation (Sodium benzenesulphochloramene) . It is used 
in the same manner and it has the same effects as chlora- 
mine T. 

Chlorcosane 

This is a thick liquid consisting of liquid paraffin con- 
taining chlorine in a stable, non-active combination. This 
substance is used merely as a solvent for dichloramine T so 
as to prevent the chlorine combining with the oil (which 
is already combined with chlorine) which would otherwise 
prevent its action. It is used as a spray. 

Holazone 

This is a complex organic chlorine compound. It acts 
like Dakin's solution but it does not decompose readily. 
It is used in tablets of 0.004-0.008 gm. together with sodium 
borate and sodium chloride. Each tablet is dissolved in a 
liter of water. 

Dichloramine T 

This is an organic chlorine compound prepared by Dakin. 
It does not dissolve very readily in water. In wounds it is 
used in 10 or 15% solutions. It is used as a spray for 
the nose and throat and in wounds; usually dissolved in 
chlorcosane, or in chlorinated paraffin or in chlorinated 
eucalyptol. 



606 MATERIA MEDICA 

OXIDIZING DISINFECTANTS 

The following drugs act as disinfectants by liberating 
oxygen when they come in contact with organic matter. 

HYDROGEN PEROXIDE 

Hydrogen peroxide or hydrogen dioxide is a liquid which 
is a chemical compound of equal parts of hydrogen and 
oxygen. A 3% solution of hydrogen peroxide is used in 
medicine. 

ACTION 

Local action: Hydrogen peroxide solution is decomposed 
when it comes in contact with organic matter, such as pus 
or blood. It then yields bubbles of oxygen. The oxygen 
then destroys the bacteria with which it comes in contact 
and disinfects the tissues. At the same time it helps to 
loosen the membranes and pieces of dead tissue (sloughs). 
The effect of the peroxide wears off very rapidly. The more 
pus or dead tissue present in the wound, the more oxygen 
is liberated. 

It is used principally to irrigate wounds or sinuses con- 
taining pus. It is also used in infections in the mouth and 
throat and other mucous membrane lined cavities. 

Hydrogen peroxide, together with sodium bicarbonate 
is used to bleach the hair. 

Preparations 

Hydrogen Dioxide 
(Aqua H drogeni Dioxidi) 

This contains about 3% of hydrogen peroxide and forms 
about ten volumes of oxygen for every volume of the per- 
oxide used. 

New and Non-official Preparations ** 

The following drugs are compounds of hydrogen peroxide 
made by replacing the hydrogen by a metal. They act as 
disinfectants and antiseptics like hydrogen peroxide, by 
liberating oxygen. Their effect is said to be more lasting, 



ANTISEPTICS 607 

however, since the oxygen is given off very slowly. They 
are often used internally as intestinal antiseptics. 

Calcium Peroxide 0.06-0.3 gm. grs. i-v 

(Calcii Peroxidatum) 

Magnesium Peroxide 0.25-0.5 gm. grs. iv-viii 

(Magnesii Peroxidatum) 

Sodium Peroxide 
(Sodii Peroxidatum) 

This is only used externally in the form of a paste or soap 
in skin diseases like acne. 

Oxone: This is a preparation of fused sodium peroxide. 

Strontium Peroxide 
(Strontium Peroxidatum) 

Zinc Peroxide 
(Zincum Peroxidatum) 

These are used externally in the form of gauze, as a dust- 
ing powder or a 10% ointment. Peroxide zinc soap is a soap 
containing 10% of zinc peroxide. 

Acetozone (Succinic Dioxide) 
Alphozone 

These are artificial chemical substances which act like 
hydrogen peroxide. They are used in 1-3000 to 1-1000 so- 
lutions on wounds, for instruments and for douches. 

POTASSIUM PERMANGANATE 

Potassium permanganate is a salt of manganese. 

When potassium permanganate comes in contact with 
organic substances, such as the albumins of the tissues, it 
combines with the albumins and liberates oxygen, which 
destroys bacteria; acting as an antiseptic and disinfectant. 
When it has combined with the albumins, it no longer 
liberates oxygen and is therefore not effectual. 

It is used in poison ivy rash. In India it is used for snake 
bite. 



608 MATERIA MEDICA 

Preparations 

Potassium Permanganate 0.06-0.2 gm. gr. i-iii 

(Potassii Permanganas) 

I For the hands and wounds it is used in 1-3% solutions. 
' It is also used as a gargle and for douches in 1-1000 to 1% 
solution. 

Zinc Permanganate 
(Zinci Permanganas) 

This acts like potassium permanganate and is principally 
used as an injection in gonorrhoea. 

Other Oxidizing Antiseptics 

Sodium Perborate 
(Sodii Perboras) 

This is the sodium salt of pel boric acid. It contains 9% 
of oxygen and is used as an antiseptic for wounds and ulcers 
and as a dusting powder. 

Perogen Bath Salts or Oxygen Bath Salts is a compound 
containing 10% of sodium perborate. 

IODOFORM 

Iodoform is a yellow crystalline powder which has a very 
characteristic odor and a sweet taste. It is a compound of 
methane (m.arsh gas) with iodine and contains about 97% 
of iodine. 

ACTION 

Local action: Applied to the skin, to wounds or mucous 
membranes, iodoform acts as a mild antiseptic and disinfec- 
tant. It absorbs the fluids from the wound and in this way 
it prevents the growth of bacteria. Iodoform is very sooth- 
ing to the skin or mucous membranes. 

Poisonous Effects 

Iodoform is often absorbed into the blood from wounds or 
sinuses, especially when the surface of the wound is very 
extensive. This is more apt to occur in adults or susceptible 



AWTiiSJbJFTKJS 609 

individuals. It produces the following characteristic poison- 
ous symptoms: 

1. In mild cases there may be only a rise of temperature; 
104° to 105° F. Headache, dizziness, very rapid pulse and 
loss of appetite, also occasionally occur. 

In severe cases the following symptoms may also occur: 

2. The patient feels depressed, downhearted, even mel- 
ancholy. 

3. Hallucinations (ideas of being persecuted and attempts 
at suicide). 

4. Delirium, even mania. 

5. Collapse, which may cause death. 

The symptoms may last for several hours or days. Oc- 
casionally there is no excitement, the patient goes into stupor 
and dies of collapse. 

Preparations 

Iodoform 0.03-0.2 gm. grs. |^-iii 

(lodoformum) 

This is used principally externally in wounds and sinuses 
in the form of Iodoform gauze. 

Iodoform gauze is made by soaking sterile gauze in a solu- 
tion containing 5-10% of Iodoform, 20-15% of glycerine 
and adding alcohol up to 100 c.c. 

Iodoform Ointment 
(Unguentum lodoformi) 

This contains 10% of iodoform. 

New and Non-official Derivatives 

lodol 0.25 gm. grs. iv 

(lodo um) 

This is an artificial chemical substance formed by the 
action of iodine on mineral oils. It contains 85% of iodine, 
but its odor is not as unpleasant as that of iodoform. 



GIO MATERIA MEDICA 

lodoformogen 
(lodoformalbumen) 

This is an odorless compound of iodoform and albumin. 
It is used principally as a dusting powder. 

Aristol 

(Thymolis lodidum) 

This is a yellowish brown powder which is used like iodo- 
form but it has a more pleasant odor. 

Europhen: This is an artificial chemical substance which 
is used as a dusting powder. It is occasionally given inter- 
nally in doses of 0.2-0.3 gm. (grs. iii-v). 

Vioform: This is an artificial chemical substance, con- 
taining iodine, which acts like iodoform. It is more efficient 
than iodoform and does not cause poisonous symptoms. 



Antiseptol 

Antiseptin 

Sozoiodol 

Sozal 

Sulphaminol 

Thiophene 



These are other unofficial derivatives of iodoform. 



BISMUTH PREPARATIONS 



A number of preparations of bismuth have been made, 
consisting of bismuth combined with a carbolic acid deriva- 
tive. The bismuth itself is only slightly disinfectant. This 
action is due to its insolubility, so that it absorbs the fluid 
from the wounds and the bacilli are unable to grow. Most 
of the antiseptic action, however, is due to the phenol de- 
rivative. 

Preparations 

Bismuth Subgallate (Dermatol) 
(Bismuthi Subgallas) 

This is used as an antiseptic dusting powder on wounds. 
Gauze soaked in bismuth is now frequently used instead of 



ANTISEPTICS 611 

iodoform gauze. Bismuth paste is frequently injected into 
deep wounds (sinuses) to make them heal more readily. 
Bismuth Subcarbolate 
(Bismuthi Subcarbolas) 

New and Non-official Preparations 

Airol 

(Bismuth lodosubgallate) 

This combines the action of iodoform and bismuth and is 
odorless. 



Thioform 

(Bismuthi Dithio Salicylate) 

Xeroform 

(Bismuthi Tribromphenolas) 

Bismuth Phenolate 

Bismuth desolate 

Bismuth Sulphocarbolate 

Dermol 

(Bismuth Chrysophenate) 

Eudoxin 



These are used as antiseptic and 
astringent dusting powders for 
wounds and various skin diseases. 
They are also given as intestinal 
antiseptics in doses of 1.0-4.0 c.c. 
(grs. xv-5i). 



PICRIC ACID 

Picric acid is a yellow crystalline powder. 

When appUed locally it checks the growth of bacteria 
(antiseptic) and contracts the skin and mucous membranes. 
It is used in the form of wet dressings on burns and other 
wounds and occasionally as douches. It is often applied in 
the form of an ointment. 

In large doses it is absorbed from the skin and causes the 
following poisonous symptoms: a yellow color of the skin 
and mucous membranes; the urine is also intensely yellow 
in color. It occasionally causes convulsions and collapse. 

BALSAM OF PERU (BALSAMUM PERUVIANUM) 

Balsam of Peru is a dark brown syrupy fluid, which does 
not dissolve in water. It is a balsam which oozes from the 
trunk of the Toluifera pereirae, a tree growing in Central 
America and India. 



612 MATERIA MEDICA 

Balsam of Peru is used in the form of gauze saturated with 
the balsam. This is applied to wounds and ulcers as an an- 
tiseptic, and to promote healing by increasing the growth 
of granulation tissue. 

When given internally, it acts as an antiseptic in the 
stomach and intestines, and aids in the expulsion of gas. 
After absorption it increases the cough and expectoration. 
Its effect is due to the benzoic acid which it contains. 

Preparations 

Balsam of Peru 0.3-1.0 c.c. m. v-xv 

(Balsamum Peruvianum) 



ANTISEPTICS 613 



ANTISEPTICS USED FOR MUCOUS MEMBRANE LINED 

CAVITIES 



BORIC ACID AND BORAX 

Boric acid or boracic acid is a weak acid formed by the 
combination of the element boron with hydrogen. 

ACTION 

Local action: Applied to the skin or mucous membranes, 
boric acid checks the growth of bacteria, but does not de- 
stroy them (antiseptic) . It is also soothing to the skin. 

Boric acid is rarely used internally, but when it is given, it 
increases the flow of urine. 

Poisonous Effects 

The irrigation of abscess cavities, the pleural cavity and 
other cavities of the body with boric acid, has occasionally 
caused the following symptoms: 

1. Abdominal pain. 

2. Nausea, vomiting and diarrhoea. 

3. Headache and dimness of vision. 

4. Collapse; rapid, thready pulse, slow shallow breathing 
and subnormal temperature. 

Death may result from the collapse. 

Continued use of boric acid even in the form of wet 
dressings, causes scaly skin eruptions such as eczema, and 
baldness. 

Uses 

Boric acid is used as an antiseptic for mucous membranes 
such as the conjunctiva. It is especially valuable as a mouth 
wash and gargle because of its mild action, and it is the 
principal ingredient of most mouth washes. It is also used 
to irrigate wounds and abscess cavities. 



614 MATERIA MEDICA 

Preparations 

Boric Acid (Boracic Acid) 0.3-1.0 gm. grs. v-xv 

(Acidum Boricum) 

For external use 2-5% solutions are employed. 

Sodium Borate (Borax) 0.3-1.0 gm. grs. v-xv 

(Sodii Boras) 



Boroglycerine 
(Glyceritum Boroglycerini) 

This is a compound formed by heating boric acid in glyc- 
erine. It contains 31% of boric acid. 

Liquor Antisepticus 

This is a compound containing 2% of boric acid together 
with benzoic acid, thymol, eucalyptol, oil of peppermint 
and oil of thyme. It is marketed under the name of Glyco 
Thymoline, 



Dobell*s Solution 

This contains li% of sodium borate, carbolic acid, 
sodium bicarbonate, glycerine and water. It is used as an 
alkaline gargle and as an antiseptic nasal douche. 

Boric Acid Ointment 
(Unguentum Acidi Borici) 

This contains 10% of boric acid. 



Listerine (Not official) 

This is a compound containing 2J% of boric acid, to- 
gether with benzoic acid, thymol, eucalyptol, oil of winter- 
green, oil of peppermint, tincture of baptista, alcohol and 
water. 

For the nose and larynx the following preparations are 
principally used: 



ANTISEPTICS 615 

Boric Acid (in 2-5% solutions) 

DobelPs Solution 

Eucalyptol 

Benzoin 

INTESTINAL ANTISEPTICS 

NAPHTHALENE 

Naphthalene is a substance obtained from coal tar. 

ACTION 

Applied to the skin or mucous membranes it checks the 
growth of bacteria. When given internally, it checks the 
growth of bacteria in the intestines thereby relieving the for- 
mation of gas. A little of the naphthalene is absorbed into 
the blood, and this is eliminated by the lungs. Here it in- 
creases the secretion of the mucous membrane and also 
acts as an antiseptic. Most of it is excreted by the foeces. 

Large doses cause symptoms like that of carbolic acid 
poisoning. 

Naphthalene is used principally as an intestinal antiseptic 
for tape worms; to increase coughing, and as an antiseptic 
for abscesses in the lungs. 

Preparations 

Naphthalene 0.06-0.3 gm. grs. i-v 

(Naphthalenum) 

Betanaphthol 0.2-0.6 gm. grs. iii-x 

(Naphthol) 

Betanaphthol Benzoate (Not official) 0.2-0.5 gm. grs. iii-viii . 
(Naphtholis Benzoas) 

This forms benzoic acid and naphthol in the intestines. 

Betol (Not official) D.3-0.5 gm. grs. v-viii 

(Naphtholis Salicylas) 

This forms salol and naphthol in the intestines. 

All these preparations should be given in keratin coated 
pills so that they will be dissolved only by the alkaline 
juices in the intestines. 



616 MATERIA MEDICA 

THYMOL 

Thymol, a substance which is principally used as a rem- 
edy for hookworms, is also used as an intestinal antiseptic. 

EUCALYPTOL 

Eucalyptol is a substance obtained from the oil of eucalyp- 
tus and other volatile oils. The oil of eucalyptus is the active 
volatile oil of the Eucalyptus globulus, or blue gum tree, 
which grows in southern countries and has the peculiar qual- 
ity of absorbing moisture from the soil. It is therefore used 
to drain swamps, and it helps to purify a malarial district 
in this way; since mosquitoes develop in swampy regions. 

ACTION 

Eucalyptol produces the following effects : 

1. Locally; it acts as an antiseptic and reddens the skin 
and mucous membranes. 

2. Internally; it checks the growth of bacteria in the intes- 
tines and increases the secretions. 

3. After absorption it increases all the secretions, such 
as the perspiration and bronchial mucus. It also makes 
the pulse stronger and faster. 

4. It is used in the treatment of malaria, as an intestinal 
antiseptic, and is inhaled in lung abscesses and fetid bron- 
chitis. 

Preparations 

Eucalyptol 0.3-1.0 c.c. m. v-xv 

Oil of Eucalyptus 0.3-1.0 c.c. m. v-xv 

Apinol 0.3-1.0 c.c. m. v-xv 

This is a substance obtained by the destructive distillation 
of pine wood. It is used principally as an intestinal antisep- 
tic and to loosen the mucus in the bronchi. 

ANTISEPTICS ACTING AFTER ABSORPTION 

The following gi'oup of drugs act as antiseptics on the 
various organs through which they are excreted. 



ANTISEPTICS 617 

ANTISEPTICS ACTING ON THE LUNGS 

CREOSOTE 

Creosote is a substance made by distilling wood tar. 
Its action is due to the guiacol which it contains. 

ACTION 

The action of creosote is similar to that of carbolic acid; 
it is not as strong an antiseptic as carbolic acid, but it is 
more poisonous. It produces the following effects : 

1. Locally, it relieves pain and acts as an antiseptic. 

2. When given internally, it acts as an intestinal anti- 
septic. 

3. It is absorbed from the intestines and it then lowers 
temperature, increases the perspiration and all the secretions, 
especially the bronchial secretions. 

4. It is eliminated by the lungs and urine. It acts as an 
antiseptic in both of these organs. 

Creosote is used principally as an antiseptic in pulmonary 
tuberculosis or lung abscesses, to destroy the bacteria in the 
lungs. It is often given by inhalation. 

Preparations 
Creosote 0.06-0.3 c.c. m. i-v 

(Creosotum) 

Creosote Water 2.0-8.0 c.c. s^i 

(Aqua Creosoti) 
This contains 1% of creosote. 

Creosote Carbonate (not official) 0.3-2.0 gms. grs. v-xxx 

(Creosotal) 

GUIACOL 

Guiacol is a colorless volatile liquid made by the distilla- 
tion of beechwood tar creosote. 

The action of guiacol is like that of creosote, with the 
following differences: 

1. It may be absorbed from the skin and then reduce 
temperature. 

2. Large doses often turn the urine a dark brown color 
and cause diarrhoea. 

It is used for the same conditions as creosote. 



0.3-1.3 gms. 


grs. v-xx 


1.0-3.0 gms. 


grs. xv-xlv 


2.0-4.0 gms. 


3H 



G18 MATERIA MEDICA 

Preparations 

Guiacol 0.5 c.c. m. viii 

Guiacol Carbonate (Duotal) 0.3-1.3 gm. grs. v-xx 

(Guiacol Carbonas) 

New and Non-Official Preparations 

Guiacol Salol 1.0 gm. grs. xv 

(Guiacolis Salicylas) 

Guiamar 

Guiajasanol 

Monotal 

(Guiacolis Methylglycolas) 

Guiacol Cinnamate 1.0 gm. grs. xv 

(Styracol) 

This combines the antiseptic properties of guiacol and 
cinnamic acid. 

GENITO-URINARY ANTISEPTICS 

The drugs in the following group are used principally as 
urinary antiseptics. They are eliminated by the urine, de- 
stroying the bacteria in the kidneys, ureters and bladder, in 
their passage through these organs. 

BENZOIC ACID AND ITS SALTS 

Benzoic acid or flower of benzoin is an organic acid ob- 
tained from benzoin; the hardened sap of the Styrax ben- 
zoini, a Peruvian tree. Benzoic acid is one of the oldest 
antiseptics known. It was contained, together with cinnamic 
acid, a closely related substance, in the balsams which the 
Egyptians used to embalm their dead. The excellent preser- 
vation of their mummies even at the present time attests to 

the efficiency of these substances. 

•* 

ACTION 

Local action: Applied to the skin or mucous membranes 
benzoic acid acts as an antiseptic. It also increases the secre- 
tion of all mucous membranes. 



ANTISEPTICS 619 

Internal action: When taken internally, benzoic acid or 
its compounds check the growth of bacteria in the intes- 
tines. It is absorbed from the stomach and intestines, and 
it then makes the pulse faster, and increases the secretions; 
especially the sweat and bronchial secretions. 

It is eliminated by the urine; which it slightly increases. 
It acts as an antiseptic along the urinary tract. It is ex- 
creted as hippuric acid, which makes the urine more acid in 
reaction. 

Preparations 
Benzoic Acid 0.3-1.0 gm. grs. v-xv 

(Acidum Benzoicum) 

Sodium Benzoate 0.3-2.U gms. grs. v-xxx 

(Sodii Benzoas) 

This is used principally as a urinary antiseptic. It is 
also frequently used as a preservative for canned foods. 

Ammonium Benzoate 0.3-2.0 gms. grs. v-xxx 

(Ammonii Benzoas) 

Lithium Benzoate 0.3-2.0 gms. grs. v-xxx 

(Lithii Benzoas) 

Benzoin 

This is the thickened sap obtained from the Styrax ben- 
zoini, a Peruvian tree. Its compounds are used principally 
to increase the secretions in the lungs, and in inflammations 
of the nose and bronchi. 

Tincture of Benzoin 2.0-4.0 c.c. 5^-i 

(Tinctura Benzoini) , 

Compound Tincture of Benzoin 2.0-8.0 c.c. 5|-ii 

(Tinctura Benzoini Composita) 

This contains benzoin, styrax, aloes and balsam of Tolu. 
It was formerly known as Balsamum traumaticum. It is 
contained in a number of old remedies, such as Friar's bal- 
sam, Turlington's balsam, Jesuit's drops, etc. It is fre- 
quently given by inhalation for inflammations of the larynx 
and bronchi. Benzoin is also contained in the balsam of 
Peru and balsam of Tolu. 



620 MATERIA MEDICA 

Cinnainic acid is a substance closely related chemically 
to benzoic acid and produces the same effects. 

Styrax or storax is the sap obtained from the inner bark 
of the Liquidamber orientalis, an Asiatic tree. It contains 
cinnamic acid. 

DRUGS CONTAINING VOLATILE OILS ACTING AS 
GENITO-URINARY ANTISEPTICS 

The following drugs act as antiseptics on the mucous 
membranes of the genito-urinary tract, by ^'irtue of the 
volatile oils which they contain. They all have practically 
the same action. 

ACTION 

When applied locally, they redden the skin or mucous 
membranes. 

When taken internally, they check the formation, and aid 
in the expulsion of gas from the intestines, and act as ca- 
thartics. They are absorbed from the stomach and intes- 
tines, but produce no effects, except a slight reduction of 
temperature. 

They are eliminated by the uime and expired air, acting 
as antiseptics on the mucous membranes of the organs 
through Avhich they are excreted. They slightly increase 
the flow of urine. 

The drugs of this group are used principally as antiseptics 
for gonorrhoea, cystitis, etc. 

Large doses often cause nausea and vomiting and various 
rashes, such as urticaria. 

Preparations 

COPAIBA: An oleoresin obtained from the sap of the 
Copaiba Langsdorfii, a tree growing in Brazil and other 
South American countries. 

Copaiba 0.6-2.0 c.c. ra. x-xxx 

Oil of Copaiba 0.6-1.0 c.c. m. x-xxx 

^Oleum Copaibae) 

CUBEBS: A powder made from the unripe fruit of the 
Piper Cupeba, an East Indian Plant. 



ANTISEPTICS 621 

Fluidextract of Cubebs 0.6-2.0 c.c. m. x-xxx 

(Fluidextractum Cubebae) 

Oleoresin of Cubebs 0.6-1.0 c.c. m. x-xv 

(Oleoresina Cubebae) 

Oil of Cubebs 0.6-1.0 c.c. m. x-xv 

(Oleum Cubebae) 

SANDAL WOOD OIL: A volatile oil distilled from the 
wood of the Santalum album, an American tree. 

Oil of Sandal Wood 0.6-1.0 c.c. m. x-xv 

(Oleum Santali) 

OIL OF ERYGERON: This is a volatile oil obtained by 
distilling Erygeron canadense, or Canada fleabane, an Ameri- 
can herb. It is used as a genito-urinary antiseptic, to check 
bleeding and to increase menstruation. 

Oil of Erygeron 0.3-2.0 m. v-xxx 

(Oleum Erygerontis) 

BUCHU: This is a substance obtained from the leaves of 
the Barosma betulina and Barosma crenulata, two South 
American plants. Its active principle is a stearoptene, Dios- 
phenol, which is excreted by the urine and acts as an anti- 
septic along the genito-urinary tract. It is used in the 
treatment of gonorrhoea. 

Fluidextract of Buchu 2.0-4.0 c.c. 3ss-i 

(Fluidextractum Buchu) 

MATICO : This is the dried tops of Piper angustifoliorum, 
a South American plant. It is used as a genito-urinary anti- 
septic. 

Fluidextract of Matico l„0-3.0 c.c. m. xv-xlv 

(Fluidextractum Matico) 

HEXAMETHYLENAMINE (UROTROPINE) 

Hexamethylenamine or Urotropine is an artificial chemical 
substance which is used principally as a urinary antiseptic. 

ACTION 

Hexamethylenamine liberates formaldehyde in the urine. 
This disinfects the urine and the mucous membranes of the 



622 MATERIA MEDICA 

genitourinary tract with which it comes in contact. It only 
acts when the urine is acid. 

It has also been used in various septic conditions because 
of the formaldehyde gas which it liberates in the blood and 
secretions. It has frequently been injected into the spinal 
canal for meningitis. 

Large doses occasionally cause burning pain in the stom- 
ach, pain on urination, and the urine occasionally contains 
blood. 

Preparations 

Hexamethylenamine 0.2-0.6 gm. grs. iii-x 

(Urotropine) 

This preparation is also on the market under various 
names, such as Formin, Aminoform, etc. Other unofficial 
compounds of Hexamethylenamine are: 

Hexalet 0.3-1.0 gm. grs. v-xv 

(Hexamethylenamine Salicylsulphonic Acid) 

Helmitol 0.3-1.0 gm. grs. v-xv 

(Hexamethylenaminae Methylencitras) 

Saliformin 0.3-2.0 gms. grs. v-xxx 

(Hexamethylenaminae Salicylas) 

Aminoform 0.3 gm. grs. v 

Formin 0.3 gm. grs. v 

Amphotropin 0.3 gm. grs. v 

Hexamethylenamine Methylene 

Citrate 0.6-1.0 gms. grs. x-xv 

METHYLENE BLUE (METHYLTHIONINAE HYDRO- 
CHLORIDUM) 

Methylene blue is a chemical substance which forms a 
deep blue solution in water. It is used principally as a 
urinary antiseptic in gonorrhoea, and as a specific for 
malaria. It stains the urine a blue or dark green color. It 
is given in capsules, in doses of 0.1-0.5 gm. (grs. ii-viii). 



CHAPTER XXXIII 

DRUGS ACTING CHIEFLY ON THE SKIN 

The drugs which are used for their effects on the skin may 
be divided into the following groups: Counterirritants and 
drugs which soothe or protect the skin. Counterirritants are 
used to irritate the skin and to produce other remote effects. 

Demulcents, emollients and protectives are substances 
which soothe and protect the skin. 

COUNTERIRRITANTS 

Counterirritants or skin irritants are drugs which are 
used principally for their effects on the skin. They produce 
two kinds of effects : local and remote. 

Local Effects 

The local effects are those produced at the site of applica- 
tion, and depend upon the length of time the drug is applied, 
or upon the strength of the preparation used. Thus, a weak 
preparation applied for a short time, produces only redness; 
if the same preparation is allowed to remain on the skin for 
a longer time, or if a stronger preparation is used, a blister 
will form. A still stronger action consists in the destruction 
of the skin, with death of the tissue (caustic or escharotic 
action) . 

Remote Effects 

The remote effects produced by counterirritants are of 
two kinds: circulatory and reflex. 

The circulatory effects are due to the reddening of the 
skin. This brings more blood to the surface of the skin from 
the underlying or deeper tissues and organs, which then be- 
come anaemic. Thus, by removing some of their blood, 
counterirritants relieve inflammation or congestion of the 

623 



624 MATERIA MEDICA 

deeper organs. For example, the application of a mus- 
tard plaster to the chest will often relieve bronchitis (inflam- 
mation of the bronchi) by withdrawing the blood from the 
inflamed bronchi to the surface of the skin. 

The reflex effects are due to the action on the nerve areas 
in the skin which are associated with those of the deeper 
organs. By affecting these nerve endings, pain in some of 
the deeper organs may be relieved. For example, the appli- 
cation of a flaxseed poultice to the ensiform cartilage often 
relieves various pains in the stomach. The other reflex 
effects of counterirritants are a slight increase in the blood 
pressure and momentary deeper breathing; but these effects 
are very slight. 

The counterirritants are best classified in the following 
way according to the effects they produce in the usual 
strengths which are commonl}^ used, though the same effects 
can be obtained from all of them. 

1. Rubefacients: Drugs that produce redness of the skin. 

2. Vesicants: Drugs that produce blisters on the skin. 

3. Caustics: Escharotics: Drugs that destro}^ the skin. 

4. Pustulants are drugs now seldom used, which form 
pustules. 

The counterirritants may be used either for their local 
effect on the skin or for their effects on the deeper organs. 

RUBEFACIENTS 

The rubefacients are used principally to redden the skin, 
to relieve congestion of the underlying tissues and to relieve 
pain in remote organs. Heat, cold applications and cupping 
may produce the same effects. 

SIN APIS— MUSTARD 

There are two kinds of mustard : 

Sinapis Alba (White Mustard) 
Sinapis Nigra (Black Mustard) 

Mustard is the powdered dried ripe seeds of Brassica 
alba and Brassica nigra, which are European plants grow- 
ing in temperate climates, throughout the world 



DRUGS ACTING CHIEFLY ON THE SKIN 625 

Black mustard is usually much stronger than the white. 

The active principles of black mustard are sinigrin, a 
glucoside, and myrosin, a ferment. 

When water is added to black mustard, it is decomposed; 
the myrosin acts on the sinigrin and changes it to dextrose, 
a sugar, and the volatile oil of mustard, which is the active 
ingredient. 

The active principles of white mustard are sinalbin, a 
glucoside, and a ferment, myrosin. 

When water is added to white mustard it is also decom- 
posed. The myrosin acts on the sinalbin, changing it to 
dextrose, a sugar, and an alkaloid, sinapine sulphate. 

ACTION 

Local Action: Applied to the skin, mustard makes it red 
and warm (rubefacient action), because it widens the cap- 
illaries. It thus draws blood to the surface from the deeper 
tissues or organs. If the application is left on for a long 
time, or if the preparation is very strong, blisters are formed 
(vesicant action) . If the application is allowed to remain on 
the skin for a still longer time, pustules may form, and the 
skin may even be destroyed at the spot of application (caustic 
action). 

Internal Action 

In the stomach, small quantities of mustard increase the 
appetite and the secretion of gastric juice, and therefore 
aid the digestion of food. For this purpose, mustard is 
never prescribed, but it is commonly used as a condiment 
with food. 

In doses in which mustard is usually prescribed, it produces 
nausea and vomiting. It is used extensively for this pur- 
pose, especially in cases of poisoning from various drugs. 

Since it causes vomiting in moderate doses, mustard 
is not absorbed, and produces no other effects, than those 
due to the vomiting. 

Methods of Administration 
For Local Applications : 

(1) Plaster: This is dipped in lukewarm water and applied. 

(2) Mustard paste : This is usually made up with flour, us- 



626 MATERIA MEDICA 

ing one part of mustard to four parts of flour. It must be 
made with tepid water, as hot water, alcohol and vinegar 
prevent the formation of the active oil which is formed and 
no effect then results from the application. 

The paste should not be applied directly to the skin, but 
by means of a piece of thin gauze or lint. 

(3) Powdered mustard may be sprinkled over an ordinary 
poultice, and the poultice then applied to the skin. 

Local applications of mustard should not be left on longer 
than fifteen to thirty minutes. 

(4) Mustard Baths are common methods of administering 
mustard for a local effect, and to relieve congestion of internal 
organs. About two to four teaspoonfuls of the dried powder 
are added to each gallon of water. 

Preparations 

White Mustard powder 
(Sinapis Alba) 

Black Mustard powder 
(Sinapis Nigra) 

Mustard Paper, or mustard plaster 
(Charta Sinapis) 

This consists of black mustard powder, to which India rubber 
is added to make it more adhesive, and the mixture is then applied 
to sheets of paper and dried. 

TURPENTINE (TEREBINTHINA) 

There are two kinds of turpentine: turpentine or white 
turpentine, and Canada turpentine or Canada balsam. 

Turpentine, or white turpentine, terebinthina, is a thick 
resinous substance, or solid oleoresin obtained from the 
sap of the Pinus palustris, and other species of pine trees. 

Canada turpentine, terebinthina canadensis, or Canada 
balsam, or balsam of fir, is a liquid oleoresin obtained from 
the Abies balsamea, the American silver fir, or balm of gilead 
tree, which grows in the northern parts of the United States. 
This form of turpentine is seldom used. The turpentines 
contain a volatile oil, oil of turpentine, or spirit of turpentine, 
which causes their effects. 



DRUGS ACTING CHIEFLY ON THE SKIN 627 



ACTION 

Local action: Turpentine or tlie spirit of turpentine, red- 
dens the skin. If it is kept on the skin for any length 
of time, it causes blisters. 

Internal Action 

When taken internally, the oil of turpentine produces the 
following effects. 

In the stomach: It checks the formation, and hastens the 
expulsion of gas. Part of it is absorbed into the blood from 
the stomach. 

In the intestines: It acts as an antiseptic, checking the 
gro'wth of bacteria. It expels gas and increases peristalsis. 
It is said to expel worms. 

On the kidneys: Turpentine and the oil of turpentine 
increase the flow of urine. This effect is produced by the 
turpentine after it is absorbed into the blood. 

Turpentine is said to make the pulse somewhat stronger 
and faster. 

Excretion 

Turpentine is eliminated from the body by the lungs, 
where it increases the cough and expectoration, and acts 
as an antiseptic. It is also excreted by the kidneys and 
gives the urine a violet color. 

Poisonous Effects 

Overdoses of turpentine cause: 

1. Unconsciousness. 

2. Scanty, often bloody urine. 

3. Rapid, feeble pulse. 

4. Occasionally vomiting, and diarrhoea, with painful 
stools. 

Uses 

Turpentine is applied to the skin to relieve pain and to 
withdraw blood from the deeper tissues; occasionally to 
form a blister. 



628 MATERIA MEDICA 

To increase the flow of urine. 
To expel gas from the intestines. 

To increase the cough and expectoration, and to check 
the growth of bacteria in the lungs. 



Administration 

For its effects on the skin, turpentine hniments are used, 
or the drug is appUed in the form of a ^' stupe." 

Turpentine Stupe 

A turpentine stupe is appUed by dipping a piece of flannel 
in hot water, to which a few drops of hot tm-pentine oil have 
been added. The flannel is wrung out, and apphed over the 
skin, which should be covered with vaseline to prevent the 
formation of blisters. Another method of applying tur- 
pentine consists of painting the skin of the abdomen with a 
mixture of one part of turpentine to two parts of an oil, such 
as olive or cottonseed oil. A piece of flannel which has been 
wrung out of hot water is then applied over the painted area 
of skin. 

Internally, turpentine is best given in capsules or in an 
emulsion. As an expectorant, it is frequently given by in- 
halations. 

Turpentine is also often added to enemas to help the 
expulsion of gas. 

Preparations 

Oil of Turpentine 0.3-1.0 c.c. m. v-xv 

(Oleum Terebinthinae) 

This is obtained by distilling turpentine. 

Purified Oil of Turpentine 0.3-1.0 c.c. m. v-xv 

(Oleum Terebinthinae Rectificatum) 

Emulsion of Turpentine Oil 4.0 c.c. 5* 

(Emulsum Olei Terebinthinae) 

Turpentine Liniment 
(Linimentum Terebinthinae) 



DRUGS ACTING CHIEFLY ON THE SKIN 629 

TEREBENE : This is a substance formed from the oil of tur- 
pentine. It acts hke turpentine but it is preferable for in- 
ternal use as an expectorant. It is given in doses of 0.3- 
2.0 c.c. (m. v-xxx.) 

CAPSICUM 

Cayenne pepper is used in the form of a plaster. For other 
actions see page 138. 

AMMONIA LINIMENT 

This contains 35% of ammonia water in cottonseed oil and 
alcohol. It is frequently used as a rubefacient. 

ARNICA 

Arnica is obtained from the flowers of the Arnica montana, 
or leopard's bane, a plant growing in northern Europe, 
Asia and the northwestern part of the United States. Its 
active principle is arnicin, an alkaloid. 

It is commonly used in the form of a tincture to absorb 
haematomata and as a counterirritant in bruises. 

Other Rubefacients 

Chloroform Liniment 
Camphor Liniment 
Sabine 
Juniper 

VESICANTS 

Vesicants or Epispastics are drugs used to produce blisters = 
In this way they withdraw fluid from the deeper tissues into 
the blister. They are used to produce this effect in joint 
affections, in various inflammations of the internal organs 
and for neuralgic pains. They may be absorbed, and may 
then weaken the patient. They should not therefore be used 
on very old patients or on infants. 



630 MATERIA MEDICA 

CANTHARIS (CANTHARIDES) 

Cantharides or Spanish fly is a dried beetle found in 
various temperate climates, especially in Spain and Italy. 
Its active principle is a neutral substance, cantharidin. 

ACTION 

Applied to the skin: it causes redness and swelling with 
the formation of a blister. Internally, in small doses it in- 
creases the flow of urine. It is said to increase sexual desire. 

Poisonous Efifects 

Absorption of cantharides from the skin, or when taken 
internally in large doses, produces the following symptoms; 
which are due to the injury of the kidneys and alimentary 
tract. 

1. Profuse vomiting and diarrhoea. 

2. Painful, scanty lurination, with scanty urine, which 
often contains blood. 

3. Delirium, convulsions and collapse. 

If it is taken in solution it causes blisters in the mouth and 
oesophagus, which often prevent swallowing. 

The symptoms are best relieved by washing out the stom- 
ach, the administration of opium for the pain, and giving 
demulcent drinks. 

Preparations 

Cerate of Cantharides 
(Ceratum Cantharidis) 

Cantharides Collodion 
(Collodium Cantharidatum) 

Tincture of Cantharides 0.12-0.3 c.c. m. ii-v 

(Tinctura Cantharidis) 

Cantharides is frequently apphed in the form of a plaster: 
a small piece of the plaster, the size of a dime is apphed over 
the affected area. 

Before applying cantharides, the skin should be shaved, 
cleansed with soap and water, alcohol and ether. The plaster 



DRUGS ACTING CHIEFLY ON THE SKIN 631 

is then applied and left on for about 4 to 8 hours, depending 
upon the effect desired. 

Cantharis Vittata: This is the dried potato fly which con- 
tains cantharidin. It is occasionally used as a substitute 
for cantharides. 

Strong Ammonia Water 
(Aqua Ammoniac Fortior) 

This is frequently used to produce blisters. 



PUSTULANTS 

Pustulants are drugs which produce very violent action on 
the skin with the formation of a group of pustules. They 
are not used very frequently. The remedies which were 
formerly used for this purpose were Croton Oil and Antimony. 

CAUSTICS OR ESCHAROTICS 

Caustics or escharotics are drugs which are applied locally 
to destroy tissues. The destroyed tissue is called the slough 
or eschar. The action may be mild or severe. The drugs 
that have a mild action are used principally in the treatment 
of various skin diseases and for the removal of scars. 

The substances that are more destructive to the tissues are 
used principally to destroy infected tissue, such as the bite of 
an animal, and to remove warts. 

Substances of Mild Action 
CHRYSAROBIN 

Chrysarobin is a substance obtained from cavities in the 
Andira araroba, a tree growing in India and Brazil. Its ac- 
tive principle is chrysophanic acid. 

When applied to the skin, it causes redness, pain and even 
swelling. Large doses, when absorbed from the skin or when 
taken internally, cause nausea, vomiting, diarrhoea and 
scanty, bloody urine. 

It is used principally in 4% ointments for the treatment 
of various skin diseases. 



632 MATERIA MEDICA 

Araroba or Goa Powder, is the crude powder frora which 
chrysarobin is made. 

SCARLET RED (not official) 

This is a chemical dye which is said to increase the forma- 
tion of granulation tissue (newly forming scar tissue) . It is 
used for this purpose in 4-8% ointments in the treatment of 
wounds and ulcers. 

THIOSINAMINE (not official) 

Thiosinamine is a crystalline, colorless substance made 
from the oil of mustard, by the action of an alcoholic solu- 
tion of ammonia. Chemically, it is called allyl sulpho- 
carbamide, allyl thiourea, or rhodaline. 

It causes absorption of scar tissue in various parts of the 
body. 

It is therefore used to remove scar tissue in the eye, the 
skin, the stomach, the urethra, etc. 

Administration 

Thiosinamine is used locally in the form of plasters or 
ointments containing 10% of thiosinamine. 

It is usually given hypodermically however, in 10% or 
15% solutions, and occasionally it is given by mouth in 
capsules. 

Preparations 

Thiosinamine 0.03-0.1 gm gr. |-1J 

(Thiosinamina) 

FIBROLYSIN (not official) 

Fibroiysin is a salt made from thiosinamine. Chemically 
it is thiosinamine sodium salicylate. 

Its action is the same as that of thiosinamine but it is more 
quickly absorbed. 

It is given hypodermically, intramuscularly, or intra- 
venously for the absorption of scar tissue in various parts of 
the body. 



DRUGS ACTING CHIEFLY ON THE SKIN 633 

Fibrolysin usually comes in small glass vials, each contain- 
ing 2.3 c.c. of fibrolysin, which is equivalent to 0.2 gm. 
(gr. iii) of thiosinamine. 

OIL OF CAJAPUT 

This is the volatile oil obtained by distilling the leaves of 
the Melaleuca leucadendron, a tree which grows in the 
Molucca Islands. 

Oil of Cajuput 0.3-1.0 c.c. m. v-xv 

(Oleum Cajuputi) 

The oil of cajuput has been used for the treatment of para- 
sitic skin diseases, and round worms. 

Substances of Severe Action 
Alkalies 
Potassium Hydroxide 
Sodium Hydroxide 

Acids 
Nitric Acid 
Glacial Acetic Acid 
Trichloracetic Acid 
Chromic Acid 
Chromic acid occurs in the form of dark purplish crys- 
tals which take up moisture from the atmosphere (hygro- 
scopic effect). 

Metals 
Zinc Chloride 
Corrosive Sublimate 
Solution of Mercurous Nitrate 
Silver Nitrate 
Copper Sulphate 
Alum 
Bromine 

DRUGS WHICH SOOTHE OR PROTECT THE TISSUES 

The drugs in this group are divided into three classes : 
1. Demulcents: Drugs which soothe the skin. 



634 MATERIA MEDICA 

2. Emollients: Drugs whicli soften the tissues. 

3. Protectives: Drugs which protect the skin. 



DEMULCENTS 

Demulcents are bland substances which are used to soothe 
inflamed tissues. They are also used to suspend substances 
which cannot otherwise be dissolved, in mixtures. 

ACTION 

The demulcents are all sticky substances which swell up 
into jelly like masses when they are dissolved in water. 
They prevent the tissues from coming in contact with in- 
jurious fluid or gaseous particles, and in this way they relieve 
the pain of inflammations and protect the tissues from in- 
jurious substances. 

Preparations 

ACACIA or GUM ARABIC: This is the gunamy sap ob- 
tained from the Acacia Senegal, an African tree. It contains 
calcium combined with arable acid. It is used in making 
emulsions of various drugs and pills. 

Mucilage of Acacia 16.0. c.c. 3iv 

(Mucilago Acaciae) 

This contains one part of acacia to two parts of water. 

Sjrrup of Acacia 
(Syrupus Acaciae) 

TRAGACANTH: This is a gummy sap obtained from the 
Astragalus gummifer, an Oriental tree. It is principally 
used to suspend heavy powders in water and in the making 
of pills. 

Mucilage of Tragacanth 16.0 c.c. 3 iv 

(Mucilago Tragacanthae) 

ULMUS or ELM: This is the inner bark of the Ulmus fulva 
or slippery elm tree of the United States. When mixed with 



DRUGS ACTING CHIEFLY ON TEE SKIN 635 

water it forms a mucilage-like substance which is very sooth= 
ing to the tissues. It is often used in the form of a poultice. 

Mucilage of Elm 
(Mucilago Ulmi) 

ALTHAEA: This is obtained from the root of Althaea offi- 
cinalis or marshmaUow. 

LINUM (flaxseed or linseed). This is the dried ripe seed 
of Linum usitatissimum or the flax plant. 

Flaxseed meal is the ground dried seeds and is used prin- 
cipally as a poultice. The seeds themselves are often given 
in the form of an infusion (flajiseed tea) to reheve bronchitis, 
painful urination and painful defecation. 

SASSAFRAS MEDULLA- This is the pith of Sassafras 
varifoliorum. The mucilage of sassafras is principally used to 
soothe inflammations of the eje, and is occasionally given 
internally. 

GLYCYRRHIZA (LICORICE ROOT): This is the root 
and underground stems of the Glycyrrhiza glabra, an Eng- 
lish plant. It is used principally to soothe mucous mem- 
branes. It has a very pleasant taste because of its active 
glucoside, glycyrrhizin, and it is used for this reason to flavor 
medicines. 

Extract of Licorice Root 1.0 gm. grs. xv 

(Extractum Glycyrrhizae) 

Fluidextract of Licorice Root 2.0 c.c. m. xxx 

(Fluidextractum Glycyrrhizae) 

AMYLUM (starch) : This is ordinary starch which is used 
in the for?TO of a dusting powder or is boiled in water and then 
applied as a demulcent. 

Glycerite of Starch (Plasmine) 
(Glyceritum Amyli) 

AMYGDALA DULCIS (Sweet Almonds). This is the seed 
of Primus amygdala dulcis or the almond tree. It contains a 



636 MATERIA MEDICA 

fixed oil and a ferment, emulsin. When the almonds are 
rubbed together with water, a bland emulsion is formed 
which is very soothing to the tissues. 

Emulsion of Sweet Almonds 16.0 c.c. 5iv 

(Emulsum Amygdalae) 

Syrup of Sweet Almonds 
(Syrupus Amygdalae) 

This is a mixture of sweet and bitter almonds and contains 
a little prussic acid. 

CHONDRUS (Irish Moss or Carragheen): This is ob- 
tained from Chondrus crispus, a seaweed found on the coast 
of Ireland and Massachusetts. It forms a jelly-like mass 
when dissolved in water because of a starchy substance, 
carrageenin, which it contains. Various preparations of 
chondrus such as lubrichondrin, are used as lubricants for 
the passage of catheters or other instruments. 

KAOLINUM (Kaolin) : This is a powder which consists of 
silicates, various salts of silicon, an element. This powder 
has the property of withdrawing fluid from tissues. It is 
used in the nose in powder to remove purulent secretions. 

It is used in the intestinal tract to absorb secretions and 
bacteria in colitis and in food poisoning and to protect the 
intestines when chronic inflammation or ulcers are present. 
It is also given to check the action of digestive ferments. 

Cataplasma Kaolini: This is a clay-like poultice consist- 
ing of boric acid, methyl salicylate, glycerine, thymol, oil 
of peppermint, and kaolin. It withdraws fluid from the 
tissues and is very soothing. It is on the market under 
various names; such as Antiphlogistine, FuUer^s Earth, etc. 

TALCUM: This is magnesium silicate and is used as a 
bland soothing dusting powder. 

LYCOPODIUM: This consists of the spores of Lycopo- 
dium clavatum or club moss. It is used principally as a 
soothing dusting powder and in the making of pills. 



DRUGS ACTING CHIEFLY ON THE SKIN 637 

EMOLLIENTS 

Emollients are bland fatty substances used to soften the 
skin and as a medium for applying other drugs to the skin. 

Preparations 

ADEPS (Lard) : This is the prepared internal fat of the 
abdomen of the pig. It is purified by washing, melting and 
straining. 

Benzoinated Lard 
(Adeps Benzoinatus) 

Ointment 
(Unguentum) 

This is a mixture of lard and yellow wax and forms the 
basis of other ointments. 

SEVUM PRAEPARATUM (Suet): This is obtained from 
the abdominal fat of the sheep. 

ADEPS LANAE HYDROSUS (Wool Fat or lanolin) : This is 
the purified fat of sheep's wool. It mixes easily with watery 
solutions and is readily absorbed by the skin. 

PETROLATUM (Paraffin) : This is made from petroleum 
after its more volatile constituents are distilled. It is used 
principally in ointments to soften the skin. Several of the 
paraffins which do not melt readily are used in surgery for 
cosmetic purposes. Some of the more fluid paraffins are 
used as laxatives. 

Petrolatum (Vaseline) 

White Petrolatum (White Vaseline) 
(Petrolatum Album) 

Liquid Petrolatum (Albolene, Russian Mineral Oil, etc.) 
(Petrolatum Liquidum) 

SURGICAL PARAFFIN OR PLASTIC PARAFFIN 

(Paraffin for Films) 

Paraffin is a wax-like substance made from petroleum. It 
is solid at ordinary room temperature but melts on heating. 



638 MATERIA MEDICA 

Paraffin is used as an excellent local application for burns, 
frostbite, chilblains or ulcers of the leg. It acts mechanically, 
by coating the burn or ulcer with a fine film which excludes 
the air. At the same time this film acts as a sort of fine 
splint thus allowing the new tissue to grow over the area. 

Method of Application 

The paraffin is melted. The wound surface is thoroughly 
dried preferably by a spray of warm air applied with an 
electric drier. The melted paraffin is then applied over the 
surface with a camel's hair brush or atomizer. A very thin 
layer of cotton is then applied over the paraffin and another 
layer of paraffin is applied over that. More cotton is placed 
over this paraffin and the part is then bandaged. 

Preparations 

ParafRnum 
Paraffin 

This melts at about 50° C. 

New and Non Official Preparations 

Stanolind Surgical Wax 

This is a specially prepared brand of paraffin. 

Parresine 

This is a mixture composed of paraffin, Japan wax, gum 
elemi, asphalt and eucalyptol. It is said to be better than 
ordinary paraffin. 

OLIVE OIL (Olgum OUvae) : This is a fixed oil obtained 
from the olive, the ripe fruit of Olea Europea; a European 
tree. 

OLEUM LINI : The fixed oil of linseed or flaxseed. 

OLEUM THEOBROMATIS (Cocoa Butter) : The fixed oil 
expressed from the roasted cocoa bean Theobroma cacao. 
It is used principally to make suppositories. 

OLEUM GOSSYPI SEMINIS (Cotton Seed Oil) : The fixed 
oil expressed from the seeds of the cotton plant. 



DRUGS ACTING CHIEFLY ON THE SKIN 639 

CETACUM (Spermaceti) : This is a fatty substance ob- 
tained from the head of the sperm whale. It is used to give 
consistency to many ointments such as cold cream. 

CERA FLAVA: The yellow wax obtained from the honey- 
comb of the bee. 

CERA ALBA: This is white wax made by bleaching the 
yellow wax. 

Both of these substances are used in making ointments, 
cerates and plasters. 

CERATUM : This is a mixture of 3 parts of wax and 7 parts 
of lard. 

GLYCERINUM (GLYCERINE) 

Glycerine is a liquid made by decomposing animal or 
vegetable fats. 

When applied to the skin or to a wounded surface, glycer- 
ine smarts and is painful for a few minutes, and then it 
softens the skin. It has the property of withdrawing fluid 
from the tissues (hygroscopic). 

It is often given internally or it is injected into the rectum. 
It then produces mild movements of the bowels without any 
colic. 

Glycerite of Starch 
(Glyceritum Amyli) 

Glycerin of Egg Yolk 
(Glyceritum Vitelli) 

There are a number of preparations of various drugs made 
up with glycerine. They are known as glycerites. 

PROTECTIVES 

Protectives are substances used to protect the tissues, 
to keep out infectious material, light or air. 

COLLODIUM (Collodion) : This is a 4% solution of py- 
roxilin or soluble gun cotton, in alcohol and ether. When 
collodion is applied to the skin, the alcohol and ether evap- 
orate, leaving a colorless transparent contractile film, which 
is strongly adherent to the skin and protects it. 



640 MATERIA MEDICA 

Collodion 
(CoUodium) 

Flexible Collodion 
(CoUodium Flexile) 

This contains Canada turpentine and castor oil in addition 
to the other ingredients, and is more pUable. 

Styptic Collodion 
(CoUodium Stypticum) 

This contains 20% of tannic acid and is therefore astrin- 
gent. 

ELASTICA (India Rubber or Caoutchouc) : The dried milky 
juice of a Brazilian tree. It is known as Para rubber. It is 
used in making adhesive plaster, bougies, etc. 

CALCII SULPHAS EXSICCATUS: This is dried gypsum 
or plaster of Paris. When dissolved in water it forms a thick 
gelatinous mass which becomes hard when exposed to the 
air. It is used in the form of a gelatinous mass or as band- 
ages filled with the dried powder. 



PART XI— MISCELLANEOUS 
CHAPTER XXXIV 

FLAVORING SUBSTANCES 

There are a number of substances which are used prin- 
cipally to flavor prescriptions containing unpleasant tasting 
drugs. Most of them are obtained from plants or fruits that 
have a pleasant aroma. 

The pleasant odor is due to volatile oils which they con- 
tain. As a result these substances may also act as carmina- 
tives, checking the formation, and aiding the expulsion of 
gas in the stomach and intestines. The following are the 
drugs and preparations commonly used as flavoring sub-= 
stances: 



AURANTII DULCIS CORTEX (Sweet Orange Peel) 
AURANTII AMARI CORTEX (Bitter Orange Peel) 

tincture of Sweet Orange Peel 4.0-8.0 c.c. 5i-ii 

"iTincture Aurantii Dulcis) 

Tincture of Bitter Orange Peel 4.0-8.00 c.c. 5i-ii 

(Tincture Aurantii Amari) 

MENTHA PIPERITA (Peppermint Leaves) 

Spirits of Peppermint 2.0-8.0 c.c. 5^-ii 

(Spiritus Menthae Piperitae) 

Peppermint Water 
(Aqua Menthae Piperitae) 

fi41 



642 MATERIA MEDICA ] 

\ 

MENTHA VIRIDIS (Spearmint Leaves) ! 

Spirits of Spearmint 4.0-8.0 c.c. 3i-ii | 

(Spiritus Menthae Viridis) 

Spearmint Watei i 

(Aqua Menthae Viridis) 

1 
CINNAMOMI CORTEX (Cinnamon Bark) j 

Cinnamon Spirits 4.0-8.0 c.c. 3i-ii j 

(Spiritus Cinnamomi) 

Cinnamon Water I 

(Aqua Cinnamomi) 

WINTERGREEN | 

Oil of Wintergreen 0.3-1.0 c.c. m. v-xv | 

(Oleum Gaultheriae) 

Spirits of Wintergreen 0.6-2.0 c.c. m. x-xxx 

(Spiritus Gaultheriae) 5% of the oil 

This contains methyl salicylate and is used for rh^Ama- 
tism. ; 

LAVANDULA (Lavender Flowers) 

Spirits of Lavender 4.0-8.0 c.c. 3i-ii ; 

(Spiritus Lavandulae) j 

Compound Tincture of Lavender 4.0-8.0 c.c. 3i-ii j 

(Tincture Lavandulae Composita) 

(This contains lavender, rosemary; cinnamon and nutmeg.) ] 



ROSA GALLICAE PETALAE (Red Rose Petals) 

Rose Water 
(Aqua Rosae) 

Unguentum Aqua Rosae 
(Cold Cream) 



FLAVORING SUBSTANCES 643 



ROSEMARY 

This is a drug obtained from the fresh flowering tops of 
Rosemarinus officinalis. 

Spirits of Rosemary 4.0-8.0 c.c. 5:-ii 

(Spiritus Rosemarini) 

It is used principally as a local application for the skin. 



CARYOPHYLUS (Cloves) 

The oil of cloves, oleum caryophilis, is the preparation com- 
monly used. It is applied on a piece of cotton for toothache, 
by inserting the cotton in the cavity of the tooth. 



ANISE 

This is tbt; fruit of the Pimpinella anisum, a European 
plant. 

Oil of Anise 0.3-1.0 c.c. m. v-xv 

(Oleum Anise) 

Spirits of Anise 4.0-8.0 c.c. 5i-ii 

(Spiritus Anisi) 

Anise is an ingredient of the Liquor ammonii anisatus 
of the German Pharmacopoeia. It is a very commonly 
used expectorant among German physicians. 



JUNIPER (Juniper Berries) 

Spirits of Juniper 4.0-8.0 c.c. 5i-ii 

(Spiritus Juniper!) 

Compound Spirits of Juniper 4.0-8.0 c.c. 5i-ii 

(Spiritus Juniperi Compo situs) 

This contains oil of juniper, caraway, and fenneL 
Juniper is used to increase the flow of urine. 



^4 MATERIA MEDICA 

AMYGDALA AMARA (Bitter Almonds) 

This is occasionally used as a carminative. 

Bitter almonds contain a glucoside, amygdalin, and a 
ferment, emulsin. The action of these substances on one 
another forms hydrocyanic or prussic acid. This never 
occurs in the ordinary preparations, but when any of the 
preparations of bitter almonds are rubbed together with 
other preparations, prussic acid may be formed. Cases of 
hydrocyanic acid poisoning have occurred from mixtures 
which were prepared in this way. 

Preparations 

Bitter Almond Spirits 1.0-4.0 c.c. m. xv-5i 

(Spiritus Amygdalae Amarae) 

Syrup of Bitter Almonds 2.0-4.0 c.c. Z}i-i 

(Syrupus Amygdalae Amarae) 

ERIODICTYON (Yerba Santa) 

Eriodictyon is obtained from the leaves of the Eriodictyon 
californicum, or the California tar bush. It is occasionally 
used as a stimulating expectorant in chronic bronchitis. 
It lessens the appreciation of bitter tasting substances. It is 
often used as a vehicle in the form of an elixir, to disguise the 
taste of bitter drugs, such as quinine. 

Preparations 

Fluid extract of Yerba Santa 1.0-4.0 c.c. m. xv-5i 

(Fluid extractum Eriodycti) 

OTHER FLAVORING SUBSTANCES 

Marrubium (Horehound) : This is the leaves and tops of 
the plant. It is used extensively as an expectorant. 

Vanilla : This is the unripe fruit of the Vanilla planif olia. The 
tincture of vanilla is the most common official preparation 
used. 



FLAVORING SUBSTANCES 645 

Limonis Cortex, Lemon PeeL 
Sassafras, Sassafras Bark. 
Foeniculum, Fennel. 
Pimenta, Allspice. 
Carum, Caraway Seeds. 
Myristica, Nutmeg. 

The oil, the spirit, and the water are the official prepara- 
tions of these substances. 

Flavoring Compounds 

Aromatic Powder 0.3-2.0 gms. grs. v-xxx 

(Pulvis Aromaticus) 

This contains cinnamon, cardamom, nutmeg and ginger, in 
powder form. 

Fluidextract of Aromatic Powder 0.5-2.0 c.c. m. viii-xxx 
(Fluidextractum Aromaticus) 

Aromatic Elixir (Elixir Aromaticum) and Elixir Adjuvans 
are preparations of the compound spirits of orange peel 
used as flavoring agents. 

SWEETENING SUBSTANCES 

Saccharin (Benzosulphinidum) : This is a chemical sub- 
stance which has a very sweet taste. It is 200 times sweeter 
than sugar and is used to sweeten foods for diabetic patients. 
It is usually given in 0.03 gm. (gr. |) doses together with 
0.3 gm. (grs. v) of sodium bicarbonate, since it dissolves 
more readily in alkaline solutions. 

Saccharum Lactis (Milk Sugar) : This is used as a flavoring 
substance and to give consistency to powders. 



CHAPTER XXXV 

PRESCRIPTION READING 

It is important for the nurse to be able to read prescrip- 
tions, as she is occasionally ordered to administer a medicine, 
the ingredients of which are written in the form of a prescrip- 
tion. 

Every prescription consists of four parts: 

1. The Superscription 

2. The Inscription 

3. The Subscription 

4. The Signature 

1. The superscription consists of the date, and the name 
of the patient; which are written at the top, (occasionally 
the name of the patient is written at the lower right hand 
corner) and the symbol R which stands for the Latin word 
RECIPE, meaning 'Hake thou.'' It is also a symbol of Jupi- 
ter, the Grecian god, and is a rehc of the days, when all 
prescriptions were begun with a prayer to him, invoking 
lais divine aid in making the ingredients more efficacious. 

2. The inscription consists of the names and the amounts 
df the ingredients used. 

The names are written in Latin, usually in the genitive 
case, for example, Camphora (genitive, Camphorae). 

The most important ingredient in the prescription is 
written first, and is often called the basis. 

The next most important ingredient is called the adju- 
vant, and is written next. 

The next substance on the prescription is usually the one 
which disguises the taste of the mixture, such as a syrup, 
and is often called the corrigent or corrective. 

The last substance on the prescription is the one in which 

646 



PRESCRIPTION READING 647 

all the others are dissolved, and it is often called the vehicle, 
excipient or menstruum. 

The quantities of the ingredients are written in the metric 
or apothecaries' system of measurement. 

In the metric system, the units used are the gramme and 
milligramme. 

In the apothecaries' system, the units used are the drachm, 
grain, minim, etc. They are written in the Arabic symbols, 
Roman numerals being used however, for the numbers, 
unless the quantity is a fraction, in which case the Arabic 
numerals are used. 

Example 

5v = 5 drachms^ 

grs. XX = 20 grains 

3ix = 9 scruples 

3i or §j = 1 ounce 

Oiii = 3 pints 

3ss = I drachm 

gr- T^TJ = iU grain 

The abbreviation ss is for the Latin word semis, meaning 
half. 

3. The subscription consists of the directions to the drug- 
gist for compounding the prescription. These are usually 
written in Latin. 

Certain abbreviations are commonly used in the subscrip- 
tion. The most common ones are the following : 

q. s. = quantum sufficiat (as much as may be necessary) 
q. s. ad = quantum sufficiat ad (as much as may be necessary to) 
M. = misce (mix) 

F. fiat, (singular) used when only one ingredient is written, 
F, fiant (plural) when many ingredients are used. 



F. 


= fiat. 


= make 


D. 


= dentur 


= give 


Div. 


= divide 


= divide 


caps. 


= capsulas 


= capsule 


pil. 


= pilulas 


= pill 


chart. 


= chartas 


= powder 


tab. 


= tabellas 


= tablet 



648 MATERIA MEDICA 

tab. trit. = tabellas triturates = tablet triturates 



troch. 


= trochiscos 


= lozenges 


supposit. 


=• suppositoria 


= suppositories 




tales 


= such 


dos. 


= doses 


= doses 


ad. scat. 


= ad scatulam 


= in the box 




pone in scat. 


= put in a box 




cochleare 


= spoon 



cochleare parvum ?= teaspoon 

The following are the most common Latin verbs used in 
prescriptions. 



aa. 



adde 


= add 


bulli 


= boU 


cola or colator = strain 


filtra 


= filter 


solve 


= dissolve 


tere 


= rub 


tere bene 


= rub well 


y are the most 


common adj 


aequalis 


= equal 


partes aequales 


= equal parts 


bulliens 


= boiled 


fervens 


= hot 


saturatus 


= saturated 


magnus 


= large 


parvus 


= small 



The signature is usually written at the end of the pre- 
scription and consists of the directions to the patient. It 
always begins with the abbreviation S. meaning signa =» 
mark (on the label). 

The quantities to be administered are written in the 
metric or apothecaries' system, for example, a teaspoonful 
is written 4.0 or 5i. A dessertspoonful is written 8.0 
or 5ii. 

The following are the abbreviations used in the signature. 
It is important for the nurse to know their definitions, as 
they may be used in her orders. 



PRESCRIPTION READING 649 



gtt. 


= gutta 




= drop 


A. M. 






= morning 


P. M. 






= evening 


0. d. 


= omne die 




= daily 


0. m. 


= omne mane 




= every day 


0. n. 


= omne nocte 




= every night 


m. et. n, 


. = mane et nocte 




= day and night 


t. i. d. 


= ter in die 




= 3 times a day 


b. i. d. 


= bis in die 




= twice a day 


q. i. d. 


= quatuor in die 




= four times a day 






(not to be given at night) 


q.h. 


= quaqua hora 




= every hour 


q. 2h. 


= quaquae duae horae 


= every 2 hours 


q. 3h. 


= quaquae tres horae 


= every 3 hours 



When medicines are ordered to be given q. 2h. or q. 3h 
etc. they must always be given at night also. 

stat. = statim = at once, immediately 

s. o. s. = si opus sit = if necessary 

This refers to only one dose. More than one dose should 
not be given if a medicine is ordered s. o. s. 

p. r. n. = pro re nata = when required 

(as often as necessary) 

When a drug is ordered p. r. n. the nurse may use her 
judgment in giving more than one dose. 

a. c. = ante cibum = before meals 
p. c. = post cibum = after meals 

At the end of the prescription, the physician's name is 
signed. 

EXAMPLES OF PRESCRIPTIONS OF FLIUD MEDICINES 

May 17, 1905 
For Mr. John Jones 
R 

Magnesii Sulphatis 3ii 

Magnesii Carbonatis 
Spiritus Ammoniac Aromatici aa 3J 
Aquae q. s. ad. 5i 

M. et. Sig. 3i t. i. d. 

Dr. Brown 



650, ^ MATERIA MEDICA 

In this prescription, the superscription is the R and Mr, 
John Jones. 

The inscription is the mixture of the ingredients, of which 
the magnesium sulphate is the most important, magnesium 
carbonate next of importance, while the water is the excipient 
or menstruum. 

The directions to the pharmacist are simply to mix the 
ingredients together (misce); and the directions to the 
nurse are to administer one teaspoonful of it three times 
a day (t. i. d.). 







May 5, 1904 


or Mr. Bates 






R 






Bismuthi Subnitratis 




15.0 


Mucilaginis Acaciae 




10.0 


Syrupus SimpHcis 




5.0 


Aquae Cinnamomi q. s 


ad. 


60.0 


Misce et. Sig. 5i q. i. d. 








Di 


. Jameston 



This prescription reads: 
For Mr. Bates.— 

Take thou, of bismuth subnitrate 15 grammes, of muci- 
lage of acacia 10 grammes, of simple syrup, 5 grammes, and 
add enough cinnamon water to make up 60 grammes. Mix 
the ingredients together and give the patient one teaspoon- 
ful of the mixture four times a day. 

This is a very good method of prescription writing. 

If the mixture is made up in a two ounce bottle, the number 
of grains of each ingredient, in every teaspoonful, is the 
same as the number of grammes of each ingredient in the 
entire mixture; since there are 60 grains in each drachm or 
teaspoonful dose, and there are 60 grammes in a two ounce 
bottle. 

For Example: In the above prescription we can see at 
once that each teaspoonful dose of the mixture contains 
15 grains of bismuth subnitrate, 10 grains of mucilage of 
acacia, etc. 



PRESCRIPTION READING 651 

EXAMPLES OF PRESCRIPTIONS OF SOLID MEDICINES 
Example June 5, 1900 

For Mr. Winsley 
R 

Extract! Colocynthidis Compositae 5ss 
Rhei grs. xxiv 

m. et divide in pilulas No. XII 
Sig. one o. n. 

Dr. Jamestain 

This prescription reads: 

Take thou, of compound extract of colocynth 2 drachms, 
and of rhubarb 24 grains, mix them together, and divide 
the mass into twelve pills. Each pill therefore contains iV 
of the whole amount, or 10 grains of the compound colocynth 
powder and 2 grains of the rhubarb. 

Example 

April 7, 1899 
For Mr. Hestar 
R 

Tabellarum Morphinae Sulphatis aa 0.015 
D. tales dos. No. XX 

Dr. Sesley 

This prescription reads, take thou of morphine sulphate 
tablets, each to contain 0.015 (15 milligrammes). Give 
twenty such doses. 

Example 





May 17, 1895 


For Mr. Hillston 




R 




* Pyramidon 


0.1 


* Phenacetine 


0.2 


Caffeinae 


0.06 


Sacchari Lactis 


0.3 


D. tales dos. No. XX et. pone 


in scat. 


M. et. fiant in chart. 




Sig. one t. i. d. 


Tir T .pa+.Arf.Qn 



* These common names are frequently used in prescriptions. 



652 MATERIA MEDICA 

This prescription reads: 

Take thou, of pyramidon 1 decigramme, of phenacetine 
2 decigrammes, of caffeine 6 centigrammes, and of milk 
sugar 3 decigrammes. Mix the ingredients together into a 
powder, and put twenty such powders in a box. Give one 
powder three times a day. 



APPENDIX 



THE HARRISON LAW 

The Harrison Law went into effect March 1, 1915. It 
was passed to regulate the sale and use of habit forming 
drugs such as opium, cocaine or their derivatives so as to 
prevent the occurrence of the habit. The following are the 
essential features of the law: 

1. Every wholesale and retail druggist who sells opium, 
cocaine, or their derivatives must be registered annually 
with the Department of Internal Revenue and pay an 
annual tax of one dollar. They are permitted to sell any of 
the substances listed under the law, only upon the written 
order of a physician, pharmacist or dentist who is also regis- 
tered with the Department of Internal Revenue. They must 
keep a record of each sale and give the purchaser a duplicate. 
All records must be kept for a period of two years and are sub- 
ject to inspection by officials of the Department of Internal 
Revenue at any time. 

2. Every physician and dentist must be registered with the 
Department of Internal Revenue and pay an annual tax of 
one dollar. They must keep a record of the quantities, and 
drugs obtained, and of their disposal. These records are sub- 
ject to inspection at any time. Prescriptions calhng for any 
substance listed under the Harrison law must bear the physi- 
cian's name, address and registry number. They must also 
contain the patient's name, age and address, and must be 
dated on the day they are written and signed by the physi- 
cian ordering them. 

3. Any unauthorized person who has any of the substances 

listed under the law in his possession, is subject to a fine of 

$2,000 or five years imprisonment or both. 

653 



654 



APPENDIX 



List of Drugs under the Harrison Law 



Opium 
Opium Powder 
Opium tablets (all strengths) 
Extract of Opium 
Dover^s Powder 
Tincture of Dover's powder 
Tinctura Opii Simplex 
Tincture of Deodorized Opium 
Morphine Sulphate (all 

strengths and all tablets) 
Magendie's Solution 
Codeine and its salts 
Codeine tablets (all strengths) 
Dionine (all strengths) 
Codeonal 
Heroin (all tablets and all 

strengths) 
Papaverine 
Pantopon 

Apomorphine Hydrochloride 
Stypticin 
Styptol 



Coca 

Fluidextract of Coca 

Cocaine 

Cocaine Hydrochloride 

Cocaine tablets (all strengths 

and all combinations) 
Codrenin 
Eucaine 
Holocaine 
Novocaine 
Tropacocaine 
Anaesthesin 
Orthoform 



M 



In addition, all mixtures or prescriptions containing 
opium, coca, or their derivatives except the following: 

1. Preparations that contain less than grs. ii of opium in 
every ounce. 

2. Preparations that contain less than gr. J of mor* 
phine, gr. i of codeine or gr. J of heroin, in every ounce. 

3. Liniments or ointments which are used externally, ex- 
cept those containing cocaine or eucaine (alpha or beta), or 
any of their salts or synthetic substances. 



Application of the Harrison Law in Hospitals 

Every hospital must be registered with the Department 
of Internal Revenue and receives a registry number and is 
subject to same regulations as physicians. 

By the following method a record may be kept of the 
quantities used of the drugs listed under the Harrison law. 



APPENDIX 655 

1. Substances listed under the Harrison law must be or- 
dered for ward use upon special blanks upon which appears 
the hospital registry number. All drugs listed in the Har- 
rison law must be ordered on one of these blanks and be 
signed by a physician. 

2. Every order calling for opium, coca, or any of their de- 
rivatives must be signed by the physician who orders it, both 
in the order book and on the chart. 

3. A special book should be kept in every ward, in which 
the nurse enters the name, date, journal number, the dose 
and the drug given. If a bottle containing any drug listed 
under the Harrison law is broken, a record of it should also 
be made. In this book the nurse is therefore able to ac- 
count for the quantities of Harrison law drugs obtained 
from the pharmacist. 



INDEX 

(The most important reference is given first) 



A. B. and S. pill, 160 
Abbreviations of terms used 

in orders, 647 
Abbreviations of terms used 

in prescriptions, 647 
Absinthe, 231 
Absolute alcohol, 340 
Absorbents, 174, 24 
Absorption, factors influenc- 
ing, 88, 90 
Absorption of drugs, 88, 12 
Acacia, 634 
Accuracy in administration, 

80 
A. C. E. mixture, 362 
Acetal, 381 

Acetanilid, 388, 384, 323 
Acetanilid poisoning, 386 
Acetozone, 607 
Acetphenetedin, 389 
Acetum opii, 318 
Acetylparethoxy, 389 
Acetylsalicylic acid, 524 
Acid, agaric, 425 

arsenious, 208 

benzoic, 617 

boracic, 613 

boric, 613 

cacodylic, 209 

carbohc, 587 

chrysophanic, 631 

cinnamic, 620 

citric. 111 

filicic, 178 

gallic, 576, 114 

hydriodic, 508 

hydrocyanic, 446, 266 

kinotannic, 572 

lactic, 112 

nitric, 108, 104 

nitrohydrochloric, 108, 
104 

oxalic, 113 

phosphoric, 461 

picric, 611 

pyrogalhc, 600 

salicylic, 518 

sulphuric, 107, 104 

tannic, 573, 114 
Acidosis, 120 
Acids, 104, 15, 9 
Acids, inorganic, 104, 15 
Acids, mineral, 104, 15 
Acids, organic, 109, 9 
Acids, plant, 109, 9 
Acidc, poisoning by, 105 



Acids, treatment of poisoning 

by, 106 
Acids, vegetable, 109, 9 
Acidum boricum, 613 
Acidum hydrochloricum di- 

lutum, 107, 104 
Acidum nitricum dilutum, 

108, 104 
Acidum nitrohj^drochloricum 

dilutum, 108 
Acidum sulphuricum dilutum, 

107, 104 
Aconite, 247, 404 
Aconitine, 247, 251 
Aconite poisoning, 249 
Aconite poisoning, treatment 

of, 250 
Acromegaly, 547 
Actior, cumulative, 14 
Action of drugs, types of, 11 
Active immunity, 532 
Active principles of drugs, 8 
Active principles of Digitalis, 

219 
Active principles of Opium, 

306 
Actol, 560 
Adalin, 329 
Adeps, 637 

Adeps benzoinatus, 637 
Adeps lanae, 637 
Adeps lanae hydrosus, 637 
Adhesive plaster, 565 
Administration by inhala- 
tion, 102 
Administration by inunctions, 

102 
Administration by mouth, 87 
Administration by rectum, 98 
Administration by the skin, 

102 
Administration by vapor, 102 
Administration for general 

effects, 85 
Administration for local ef- 
fects, 81 
Administration for systemic 

effects, 85 
Administration of acids, 94 
Administration of alkalies, 

118, 100, 94 
Administration of alkaloids, 

96, 100 
Administration of bougies, 84 
Administration of cathartics, 

175, 100, 148, 94, 98 
Administration of cerates, 84 
Administration of douches, 82 



Administration of galenicals, 

96, 101 
Administration of gargles, 83 
Administration of glucosides, 

96, 101 
Administration of inorganic 

salts, 94, 100 
Administration of liniments, 

83 
Administration of medicines, 

78, 100 
Administration of metallic 

salts, 95, 100 
Administration of mineral oil, 

98, 101 
Administration of mouth 

washes, 83 
Administration of oils, 98, 101 
Administration of oleates, 84 
Administration of ointments, 

S3, 102 
Administration of plasters, 84 
Administration of poultices, 

84 
Administration of serums, 

540 
Administration of vaccines, 

540 
Administration, time of, 92, 

100 
Adnephrin, 245 
Adonidin, 231 
Adonis vernalis, 231 
Adrenal extract, 550 
AdrenaUn, 240 
Adrenalin chloride solution, 

244 
AdrenaUn inhalant, 244 
Adrenalin ointment, 244 
Aether, 346 
Afridol. 602 
Agar-agar, 150 
Agar-agar with Calumba, 151 
Agar-agar with Gentian, 151 
Agar-agar with Phenol- 

phthalein, 151 
Agaric acid, 425 
Agaricin, 425 
Agaricus, 425 
Agurin, 469 
Airol, 569, 611 
Albargin, 559 
Albolene, 151, 637 
Alcohol, 330, 240, 593 
Alcohol, Amyl, 345 
Alcohol, Butyl, 345 
Alcohol, Ethyl, 330, 240, 264, 

593 

657 



658 



INDEX 



Alcohol, Methyl, 343 

Alcohol poisoning. Acute, 334 

Alcohol poisoning, treatment 
of, 336 

Alcohol, Propyl, 345 

Alcoholic beverages, 340 

Alcoholism, 336 

Ale, 343 

Aleuronat, 538 

Alkalies, 115, 15 

AlkaUes, poisonous effects of, 
116 

Alkaline astringents, 571 

AlkaUne earths, 122 

Alkaloids, 9 

Alkaloids of Opium, 306 

Allspice, 622 

Aloes, 159 

Aloin, 159, 160 

Alphozone, 607 

Alteratives, 457 

Althaea, 635 

Alum, 561, 185, 146, 633 

Alum, dried, 561 

Alumen, 561 

Alumen exsiccatum, 561 

Aluminium, 561 

Aluminium acetate, Solution 
of, 561, 603 

Aluminium naphtholsulpho- 
nate, 562, 602 

Aluminium sulphate, 561 

Alumnol, 562, 602 

Alypin, 442 

American hellebore, 251, 404 

Aminoform, 622 

Ammonia, 234, 264 

Ammonia liniment, 238, 629 

Ammonia poisoning, 236 

Ammonia poisoning, treat- 
ment of, 237 

Ammonia water, 238 

Ammoniated tincture of Val- 
erian, 393 

Ammonium, 234 

Ammonium acetate solution, 
238 

Ammonium benzoate, 619 

Ammonium bromide, 329, 
324 

Ammonium carbonate, 239 

Ammonium chloride, 267, 239 

Ammonium ichthyosulpho- 
nate, 598 

Ammonium iodide, 515 

Amphotropin, 622 

Amygdala amara, 644 

Amygdala dulcis, 635 

Amygdalin, 270, 644 

Amylene chloral, 381 

Amylene hydrate, 379, 266 

Amyl nitrite, 253, 254 

Amylopsin, 127 

Amylum, 635 

Anaesthesin, 444 

Anaesthetic mixtures, 362 

Anaesthetics, 346, 433, 18, 24 

Anaesthetics, general, 336, 18 

Anaesthetics, local, 433, 19 

Anaesthol, 362 

Analeptics, 24 

Analgen, 391 



Analgesic antipyretics, 384, 

18 
Analgesics, 305, 324, 18, 24 
Anaphalaxis, 540 
I Anchylostoma duodenale, 185 
I Anions, 89, 324 
I Anise, 643 

j Anisotonic solution, 189 
Anodynes, 305, 24 
Antacids, 115, 15, 25 
Antagonistic action, 14 
Anthelmintics, 176, 16, 24 
Anthemis, 136 
Anthracene cathartics, 175 
Anthrasol, 602 
Antiaris, 219 
Antiarthritics, 24 
Antidiphtheritic globulins, 

535 
Antidotes of Metals, 557 
Antidysenteric serum, 534 
Antifebrine, 388 
Antiformin, 601 
Antigonococcus serum, 533 
Antihj'sterics, 392 
Antikamnia, 391 
Antilithics, 24 
Antimeningococcus serum, 

534 
Antimony, 145, 404, 631 
Antimony and potassium tar- 

tarate, 146 
Antinervine, 391 
Antiperiodics, 24 
Antiphlogistine, 636 
Antipneumococcus serum, 

533 
Antipyretics, 382, 24, 18 
Antipyretics, uses of, 391 
Antipyrine, 388, 381, 323 
Antipyrine cum ferro, 388 
Antipyrine mandelate, 388 
Antipyrine poisoning, 386 
Antipyrine salicylate, 388, 

525 
Antirabic vaccine, 538 
Antiseptics, 581, 25, 22 
Antiseptin, 610 
Antiseptol. 610 
Antisialogogues, 25 
Antispasmodics, 392, 25 
Antistaphylococcus serum, 

533 
Antistreptococcus serum, 533 
Antithyroidin Moebius, 545 
Antitoxic serum, 534 
Antitoxins, 534, 21 
Antityphoid serum, 534 
Antizymotics, 25 
Apenta water, 168 
Aperients, 149 
Apinol, 616 
Apiol, 489 
Apioline, 489 
Apnoea, 263 

Apocodein hydrochloride, 269 
Apocynum, 230, 473 
Apomorphine, 144 
Apomorphine hydrochloride, 

145 
Apothecaries' equivalents of 
Metric units, 33 



Apothecaries' fluid measure- 
ment, 32 

Apothecaries' system of meas- 
urement, 32 

Apothecaries' weight mea:- 
urement, 32 

Approximate Apothecaries' 
equivalents of Metric 
\xnits, 33 

Approximate JNIetric equiva- 
lents of Apothecaries' 
units, 33 

Aqua ammoniae, 238 

Aqua ammoniae fortior, 238 

Aqua camphorae, 234 

Aqua cinnamomi, 642 

Aqua fortis, 108 

Aqua hamamelis, 578 

Aqua hydrogeni dioxidi, 607 

Aqua menthae piperitae, 618, 
641 

Araroba, 632 

Arbutin, 471 

Argentamin, 559 

Argenti ichthyosulphonas, 
560 

Argenti nitras, 558 

Argenti proteinas, 560 

Argentum, 557 

Argonin, 560 

Argyria, 557 

Argyrol, 559 

Aristochin, 499 

Aristol, 610 

Arnica, 629 

Aromatic bitters, 136 

Aromatic elixir, 645 

Aromatic powder, 645 

Aromatic spirit of ammonia, 
238 

Aromatics, 25 

Arrow poison, 229 

Arsaminol, 518 

Arsenic, 203 

Arsenic iodide, 209 

Arsenic poisoning, Acute, 206 
Arsenic poisoning, Cumula- 
tive, 207 
Arsenic poisoning, treatment 

of, 206 
Arsenic tolerance, 205 
Arsenic trioxide, 209 
Arsenious acid, 208 
Arsenobenzol, 516, 518 
Arsen triferrin, 209 
Arsphenamine, 516, 518 
Arsphenolamine hydrochlor- 
ide, 518 
Arsphenolamine S, 518 
Arterial depressants, 253, 17 
Arterial stimulants, 240, 17 
Artificial alkaloids of Mor- 
phine, 320 
Artificial Cerisbad salt, 166 
Asafoetida, 139 
Asaprol, 391 
Ascarides, 184 
Aspidium, 177 
Aspidium filix mas, 177 
Aspidium poisoning, 177 
Aspidosperma, 264 
Aspirin, 524, 323 



INDEX 



659 



Astringents, 554, 25, 21 

Atophan, 528 

Atoxyl, 209 

Atropa belladonna, 410 

Atropine, 410, 418, 419, 420, 

491, 264, 239 
Atropine, Appearance of pa- 
tient, 410 
Atropine group of drugs, 409 
Atropine ointment, 418 
Atropine poisoning, 414 
Atropine poisoning, treat- 
ment of, 416 
Atropine Sulphate, 418 
Attention, mode of action, 

276 
Auricular fibrillation, 215, 

226 
Auriculo ventricular bundle 

of the heart, 214 
Aurantii amari cortex, 641 
Aurantii dulcis cortex, 641 
Aurum (Gold), 462 
Autogenous vaccines, 532 
Azedarach, 183 



Bacillus Bulgaricus, 537 
Bacillus Coli vaccine, 536 
Balsam of fir, 626 
Balsam of Peru, 611 
Balsam of Tolu, 269 
Balsamum Traumaticum, 619 
Balsams, 11 
Barbital, 374 
Barium, 570 
Barium sulphate, 570 
Base of a salt, 324, 89 
Basedow's disease, 544 
Basham's mixture, 199 
Basis of a prescription, 646 
Bearberry, 471 
Beer, 343 
Belladonna, 410 
Belladonna, Appearance of 

patient, 410 
Belladonna, extract of, 417 
Belladonna liniment, 418 
Belladonna plaster, 417 
Belladonna poisoning, 414 
Belladonna, tincture of, 417 
Benzanilide, 391 
Benzoate of soda, 619 
Benzoic acid, 596, 618 
Benzoin, 619, 615, 271 
Benzoinated lard, 637 
Benzol, 210 

Benzolsulphinidum, 645 
Benzyl benzoate, 425 
Berberine, 134, 485 
Berberis, 134 
Beta Eucaine, 441 
Beta Eucaine hydrochloride, 

441 
Beta Eucaine lactate, 441 
Betanaphthol, 615 
Betanaphthol benzoate, 615 
Betol, 525, 615 
Bhang, 321 
Bichloride of Mercury, 592, 

583, 499, 603, 507 



Biniodide of Mercury, 507 
Bismal, 569 
Bismon, 570 
Bismuth, 568 
Bismuthal, 570 
Bismuth and Ammonium cit- 
rate, 569 
Bismuth and Iron Citrate 

570 
Bismuth Beta Naphtholate 

569 
Bismuth bitannate, 570 
Bismuth cresolate, 611, 569 
Bismuth iodosubgallate, 569, 

611 
Bismuth methylen digallate, 

569 
Bismuth paste, 568 
Bismuth phenolate, 611 
Bismuth poisoning, 568 
Bismuth subcarbolate, 611 
Bismuth subcarbonate, 569 
Bismuth subgallate, 569, 610 
Bismuth subnitrate, 569 
Bismuth sulphocarbolate, 611 
Bismuth tribromphenolate, 

570, 611 
Bitter almonds, 644 
Bitter cucumber, 169, 171 
Bitter orange peel, 641 
Bitters, 133, 25, 15 
Blackberry, 578 
Black drop, 318 
Black haw, 490 
Black mustard, 624 
Black snake root, 528 
Black wash, 508 
Blaud's pills, 198 
Bleaching powder, 586 
Blindness following wood al- 
cohol poisoning, 344 
Blood clotting, 192 
Blood, formation of, 187 
Blood, physiology of, 187, 192 
Blood root, 269, 324 
Blood stimulants, 187 
Blue gum tree, 616, 136 
Blue mass, 507, 155 
Blue ointment, 508 
Blue stone, 567 
Blue vitriol, 567 
Blumgarten's method for 
calculating doses from 
stock solutions, 68 
Blumgarten's rule for making 
a desired solution from a 
stock solution, 51 
Blumgarten's rule for making 
weak solutions from 
strong ones, 51 
Body temperature, mode of 

production, 382 
Body temperature, method 

of regulating, 382 
Boneset, 136 
Bonjean's extract of Ergot, 

483 
Boracic acid, 613 
Borax, 613 
Boric acid, 613 
Boric acid ointment, 614 
Bornyval, 393 



Boroglycerine, 614 

Boro sal solution, 523, 603 

Bougies, 84 

B. P., 7 

Brain depressants, 304 

Brain, functions of, 273 

Brain, motor action of, 273 

Brain, sensory action of, 273 

Brain stimulants, 273 

Brandy, 340, 292 

Braun's solution, 439 

Brayera, 178 

Brimstone, 150 

British Pharmacopoeia, 7 

Bromal hydrate, 371 

Brometone, 329 
Bromides, 324, 366, 266 
Bromides, Appearance of pa- 
tient, 324 
Bromides, comparative ac- 
tion of, 328 
Bromides, poisonous symp- 
toms of, 327 
Bromidia, 330 
Bromine, 586, 633 
Bromiol, 329 
Bromipin, 329 
Bromism, 327 
BromocoU, 330 
Bromoform, 379 
Bromo mangam, 330 
Bromural, 376 
Broom tops, 470 
Brovalol, 324, 386, 330, 393 
Brown's mixture, 318, 270 
Brucine, 297 
Buchu, 621, 477 
Bulgaric tablets, 537 
Burgundy wine, 342 
Burnett's disinfecting fluid, 

567 
Burnt alum, 561 
Burow's solution, 561, 603 
Butyl chloral hydrate, 369 



Cachet, 3 

Cacodyl (Arsenic) deriva- 
tives, 209 

Cacodylic acid, 209 

Caffeine, 292, 240, 264, 467 

Caffeine citrate, 296 

Caffeine sodium benzoate, 
296 

Calabar bean, 404 

Calcii sulphas exsiccatus, 640 

Calcined magnesia, 165, 126 

Calcium bromide, 329 

Calcium chloride, 125 

Calcium glycerophosphate, 
462 

Calcium hypophosphite, 461 

Calcium ichthyol, 598 

Calcium lactate, 125 

Calcium peroxide, 607 

Calcium salts, 122, 194 

Calcium salts in clotting of 
blood, 192 

Calculation of doses, 63 

Calculation of doses from 
stock solutions, 65 



660 



INDEX 



Calculation of doses from 
tablets. 63 

Calculation of hypodermic 
doses, 63 

California buckthorn, 153 

Calomel, 154, 507, 472, 186 

Caiomelol, 510 

Calumba, 134, 185 

Calx, 122 

Calx chlorinata, 586 

Camelia thea, 579 

Camphor, 231, 264 

Camphorated tincture of Opi- 
um, 317 

Camphoric acid, 426 

Camphor liniment, 234 

Camphor oil, 234 

Camphor spirit, 234 

Camphor, use of in Pneu- 
monia, 233 

Camphor water, 234 

Cannabinol, 321 

Cannabis indica, 321 

Canada balsam, 626 

Canada turpentine, 626 

Canadian hemp, 230 

Cantharides, 630 

Cantharides collodion, 530 

Cantharis, 630 

Cantharis vittata, 631 

Caoutchouc, 640 

Capsicum, 138, 629 

Capsule, 3 

Carbohydrate preparations, 
454 

Carbohydrates, 449 

Carbolic acid, 587 

Carbolic acid derivatives, 590 

Carbolic acid ointment, 590 

Carbolic acid poisoning, 588, 
568. 

Carbolic acid poisoning, 
treatment of, 589 

Carbo ligni, 174 

Cardamomum, 139 

Cardamom, 139 

Cardiac depressants, 247, 
253, 25 

Cardiac sedatives, 247, 253 

Cardiac stimulants, 218 

Cardiac stimulants, compara- 
tive action of, 246 

Cardiac stimulants, table of, 
246 

Cardio accelerator center of 
medulla, 280 

Cardio inhibitory center of 
medulla, 280 

Care of measuring apparatus, 
79 

Care of medicines, 78 

Cargentos, 560 

Carlsbad salt, 166 

Carlsbad water, 168 

Carminative action, 137 

Carminatives, 137, 25 

Carolina jasmine, 484 

Carrageenin, 636 

Carragheen, 636 

Carraway seeds, 645 

Carrel Dakin method of 
treating wounds, 604 



Carron oil, 125 
Carum, 645 
Caryophylus, 643 
Cascara, 153 
Cascara sagrada, 153 
Casoid diabetic flour, 450 
Cassia fistula, 150 
Castor oil, 156 
Castor oil cocktail, 158 
Cataplasma kaolini, 636 
Catechutannic acid, 572 
Cathartic enemata, 173 
Cathartics, 147, 25, 16 
Cathartics, active principles 

of, 175 
Cathartics, administration of, 

148, 175, 100, 101 
Cathartics, classification of, 

149, 174 
Cathartics, drastic, 168 
Cathartics, rapidity of action 

of, 174 

Cathartics, site of action of, 
174 

Cathartics, saline. 163 

Cathartics, summary of, 174 

Cathartics, vegetable (in- 
cluded in Simple purga- 
tives), 154 

Cathartic vegetable pills, 172 

Cations, 89, 324 

Caustic potash, 121 

Caustic soda, 118 

Caustics, 631, 25, 23 

Cayenne pepper, 138, 629 

Celandine, 324 

Cell stimulating diuretics, 467 

Centers of IMeduUa Oblon- 
gata, 280 

Cera alba, 639 

Cera flava, 639 

Cerate of lead subacetate, 565 

Ceratura, 639 

Cerebellum, action of, 279 

Cerebral depressants, 304 

Cerebral stimulants, 286, 294 

Cerebral stimulation, 285 

Cerebrum, action of, 273 

Cerium oxalate, 570 

Cetacum, 639 

Cetrarin, 135 

Cevadilla, 252 

Chalk, 122 

Chalk mixture, 126 

Chamomile, 136 

Champagne, 342 

Charcoal, 174 

Charta, 4 

Chemical action of drugs, 13 

Chenopodium, 183, 186 

Cherrj^ water, 343, 140 

Chinaphenin, 499 

Chinosol, 602 

Chirata, 134 

Chloral, 366, 266 

Chloral, Appearance of pa- 
tient, 360, 367 

Chloral camphor, 371 

Chloral collapse, 368 

Chloral, dangers in use of, 368 

Chloralformamid, 371 

Chloral hydrate, 366 



Chloral poisoning, 368 

Chloralose, 372 

Chloramine B, 605 

Chloramine T, 605 

Chlorazene, 605 

Chlorcosane, 605 

Chloretone, 371 

Chlorinated lime, 586 

Chlorine, 584 

Chlorine water, 586 

Chlorodyne, 359 

Chloroform, 354 

Chloroform, administration 
of, 358 

Chloroform anaesthesia, 354 

Chloroform collapse, 357 

Chloroform collapse, treat- 
ment of, 358 

Chloroform, comparison of 
action with Ether, 360 

Chloroform hniment, 360 

Chloroform poisoning, 356, 
358 

Chlorum, 584 

Cholagogue cathartics, 154 

Cholagogues, 25 

Chondrus, 636 

Christmas rose, 221 

Chromic acid, 633 

Chronic Cocaine poisoning, 
437 

Chronic Iodine poisoning, 
595 

Chronic Mercury poisoning, 
497, 505 

Chronic Mercury poisoning, 
treatment of, 506 

Chronic Opium poisoning, 
313 

Chronic Wood alcohol poi- 
soning, 345 

Chrysarobin, 639 

Chrj'sophanic acid, 631 

Churrus, 321 

Cimicifuga, 528 

Cinchona, 492 

Cinchona calisaya, 492 

Cinchona rubra, 492 

Cinchonidine, 493 

Cinchonine, 492 

Cinchophen, 528 

Cinnamic acid, 620 

Cinnamon, 642 

Cinnamon water, 642 

Ciose, 450 

Circulation of the blood, 211 

Circulatory depressants, 247 

Circulatory diuretics, 472 

Circulatory stimulants, 211 

Citrate of Magnesia solution, 
167 

Citric acid. 111 

Citrine ointment, 508 

Claret, 342 

Classification of drugs, 15 ' 

Cloves, 643 
Club moss, 636 

Coagulen, 193 ■ 

Coal tar, 384 

Coal tar derivatives, 384 

Coca, 433 

Cocaijje, 433 



INDEX 



661 



Cocaine, Appearance of pa- 
tient, 433 

Cocaine habit, 437 

Cocaine hydrochloride, 440 

Cocaine poisoning. Acute, 436 

Cocaine poisoning, treatment 
of, 437 

Cocoa butter, 638 

Codeine, 319, 306, 266 

Codeine phosphate, 319 

Codeine sulphate, 319 

Cod liver oil, 455 

Cod liver oil, administration 
of, 455 

Coffee, 292 

Coffee habit, 295 

Cognac, 340 

Colchicine, 525 

Colchicum, 525 

Colchicum seeds, 527 

Colchicum stems, 527 

Cold cream, 579, 642 

Coley's serum, 536 

Collargol, 559 

Collargol ointment, 559 

Collodion, 640 

Collodion flexile, 640 

Collodium, 640 

CoUodium cantharidatum, 
630 

Colloidal Bismuth oxide, 570 

Colloidal Calomel, 510 

Colloidal Silver, 559 

Colocynth, 171 

Colocynthin, 171 

Comparative action of Chlo- 
roform and Ether, 360 

Comparative action of bro- 
mides, 328 

Complex emotions, mode of 
action, 379 

Compound Acetanihd pow- 
der, 388 

Compound cathartic pill, 172 

Compound Chloroform lini- 
ment, 360 

Compound Effervescent pow- 
der (Seidlitz Powder) , 
166 

Compound Fluidextract of 
Sarsaparilla, 463 

Compound Iodine solution, 
596 

Compound Iron mixture, 200 

Compound Licorice powder, 
162 

Compound Morphine pow- 
der, 319 

Compound Rhubarb powder, 
159 

Compound Spirits of Ether, 
394, 354 

Compound Syrup of Hypo- 
phosphites, 463 

Compound Syrup of Sarsa- 
parilla, 463 

Compound tincture of Ben- 
zoin, 619 

Compound tincture of Opi- 
um, 318 

Concentrated fluid prepara- 
tions, 5 



Concentrated preparations, 4 
Concentrated solid prepara- 
tions, 3 
Conditions influencing dos- 
age, 62 
Condurango, 135 
Confection of Senna, 161 
Confections, 3 
Conium, 428 
Conium poisoning, 429 
Conquinine, 492 
Conscious actions, nature of, 

282, 276 
Consciousness, 276 
Contractility of heart muscle, 

213 
Convalliamarin, 230 
Convallaria, 230 
Convallarin, 230 
Convulsants, 25 
Convulsions, 286 
Convulsions, clonic, 286 
Convulsions, tonic, 286 
Copaiba, 620, 47 
Copper, 567 
Copper sulphate, 567, 146, 

633 
Cornutol, 484 
Corpus luteum, 552 
Corpus luteum dessicated, 

552 
Corrective of a prescription, 

646 
Correctives, 26 
Corrosive sublimate, 603, 

592, 507, 633 
Cotarnine hydrochloride, 487 
Cotarnine phthalate, 487 
Cotton root bark, 490 
Cotton seed oil, 638 
Couch grass, 472 
Coughing, mechanism of, 

263 
Counterirritants, 623, 26, 

22 
Cramp root, 490 
Cream of tartar, 475, 165 
Credo's ointment, 559 
Cremo bismuth, 562 
Creolin, 591 
Creosotal, 617 
Creosote, 617 
Creosote carbonate, 617 
Cresol, 525, 591 
Cresols, 590 
Cretinism, 543 
Croton oil, 169 
Croton oil, administration of, 

169 
Crurin purum, 570 
Cubebs, 620, 477 
Cumulative action of a drug, 

14 
Cumulative symptoms, 14 
Cupri sulphas, 567, 146, 

633 
Cuprum, 567 
Curara, 431 
Cusso, 178 

Cyanosis, nature of, 263 
Cycloform, 444 
Cypripedium, 396 



Dakin's solution, 603 
Dandelion, 135 
Daphnin, 464 
Datura stramonium, 410 
Deadly nightshade, 410 
Decigramme, 31 
Decoction of Scoparius, 470 
Decoctions, 6 

Delayed Chloroform poison- 
ing, 358 
Delirifacients, 26 
Delirium, nature of, 286 
Delirium tremens, 337 
Delphinine, 251 
Delphinium, 251 
Demulcents, 634, 26, 23 
Deodorants, 581, 26 
Deodorized Opium, 316 
Deodorized tincture of Opi- 
um, 317 
Depilatories, 26 
Depressants, 15 
Depressants of motor nerve 

endings, 426, 409 
Depressants of secretory 

nerve endings, 409 
Depressants of sensory nerve 

endings, 433 
Depressants of nerve endings, 

409 
Depression, 15 
Depression of blood forming 

organs, 187 
Depression of Cardio acceler- 
ator center, 290 
Depression of Cardio inhibi- 
tory center, 290 
Depression of medulla ob- 
longata, 290 
Depression of mental func- 
tions of brain, 290 
Depression of nerves, 290 
Depression of nerve endings, 

290, 398 
Depression of sensations, 289 
Depression of speech center, 

289 
Depression of spinal cord, 290 
Depresso motors, 426, 409 
Depurants, 26 
Dermatol, 569, 610 
Dermol, 611 

Dessicated hypophysis, 549 
Dessicated Pituitary gland, 

549 
Dessicated Pituitary sub- 
stance, 549 
Detergents, 26 
Dextrose, 454 
Diabetic flour, 450 
Diabetin, 454 
Diachylon ointment, 565 
Diachylon plaster, 565 
Diagram illustrating action 

of heart, 214 
Diagram illustrating action of 

Nervous system, 284 
Diaphoretics, 398, 403, 26 
Diaspirin, 524 
Diarsenol, 518 



662 



INDEX 



Diastole of heart, 212 

Diazyme essence, 130 

Diazyme glycerole, 131 

Dichloramine T, 605 

Diethyl Barbituric acid, 375 

Diffusion, 88, 13 

Digalen, 227 

Digestants, 127, 26, 15 

Digestion, 103 

Digestion of proteins, 103 

Digestion of starches, 103 

Digestives, 127, 26, 15 

Digifoline, 228 

Digipoten, 228 

Digipuratum, 222, 228 

Digitalin, 219 

Digitalins, 228 

Digitalis, 219, 473 

Digitalis, action on circula- 
tion, 220 

Digitalis, administration of, 
224 

Digitalis, Appearance of pa- 
tient, 226 

Digitalis, cumulative poison- 
ing, 223 

Digitalis, Fluidextract of, 227 

Digitalis group, 218 

Digitalis, Infusion of, 227 

Digitalis poisoning, 223 

Digitalis, Tincture of, 227 

Digitan, 228 

Digitol, 228 

Digitonin, 219 

Digitoxin, 219, 228 

Dilute Acetic acid, 109 

Dilute Hydrobromic acid, 329 

Dilute Hydrochloric acid, 107 

Dilute Hydrocyanic acid, 
446, 266 

Dilute Nitric acid, 108 

Dilute Nitrohydrochloric 

acid, 109 

Dilute Phosphoric acid, 461 

Dilute Sulphuric acid, 107 

Dimethylaminoantipyrina , 
389 

Dimethyl Piperazine tartar- 
ate, 527 

Dionine, 320 

Diosphenol, 621 

Diphtheria Antitoxin, con- 
centrated, 535 

Diphtheria Antitoxin serum, 
534 

Disinfectants, 581, 26 

Dispensatory, 8 

Dissociation, 89 

Distillation, 331 

Division method of calcu- 
lating doses, 66 

Diuretics, 466, 26, 19 

Diuretin, 469 

Dobell's solution, 614, 615 

Donovan's solution, 208, 508 

Dormiol, 381 

Dosage, 62 

Dosage, conditions influenc- 
ing, 62 

Dosage, Young's rule for, 73 

Dover's powder, 316, 143 

Dram, 32 



Drastic cathartics, 168 

Drastic purgatives, 168 

Dried alum, 561 

Dried Suprarenal gland, 244, 
551 

Drugs acting on tke blood, 
186 

Drugs acting on the blood 
vessels, 240, 253 

Drugs acting on the brain, 
272 

Drugs acting on the gastro- 
intestinal tract, 103, 15 

Drugs acting on the genital 
organs, 20, 478 

Drugs acting on the heart, 
211, 247, 17 

Drugs acting on the involun- 
tary' muscles, 404, 19 

Drugs acting on the kidneys, 
466, 19 

Drugs acting on the central 
nervous system, 272, 18 

Drugs acting on the periph- 
eral nerve endings, 398, 
19 

Drugs acting on the respira- 
tion, 261, 17 

Drugs acting on the secretory 
glands, 398, 19 

Drugs acting on the skin, 623 

Drugs, administration of, 78 

Drugs, Dosage of, 62 

Drugs, Idiosyncrasies of, 14 

Drugs which contract blood 
vessels, 240 

Drugs which destroy hook 
worms, 185 

Drugs which destroy thread 
worms, 184 

Drugs which stimulate in- 
voluntarj.' muscles, 404 

Dry red wines, 342 

Dry peptonoids, 450 

Dry Thiol, 599 

Dry white wines, 342 

Drj' wines, 341 

Duboisia, 424, 410 

Duboisine, 424 

Dunbar's serum, 538 

Duotal, 618 

Dyer's oak, 572 

Dyspnoea, 562 



Eau de Cologne, 343 

Ecbolics, 478, 26, 20 

Effervescent draught, 475 

Effervescent Magnesium sul- 
phate, 167 

Effervescent Potassium cit- 
rate, 475 

Effervescent Lithium citrate, 
476, 167 

Effervescent Saline purga- 
tives, 166 

Effervescent Sodium phos- 
phate, 167 

Elastica, 640 

Elaterine, 170 



Elaterium, 170 
Elixir ad ju vans, 645 
Elixir Aromaticum, 645 
Ehxir of Enzymes, 129 
Elixir of Iron, Quinine and 
Strychnine phosphate, 
200, 303 
Elixirs, 6 
Elm, 634 

Emetics, 141, 26, 16 
Emetine, 529, 144, 141 
Emetine hydrochloride, 529, 

144, 141 
Emmenagogues. 488, 478, 26 
Emollients, 637, 26, 23 
Emotions, nature of, 277 
Empiric action of drugs, 14 
Emplastrum, 3, 4 
Emplastrum adhaesivum, 565 
Emplastrum belladonnae, 417 

Emplastrum capsici, 138 

Emplastrum plumbi, 565 

Emulsin, 270, 636 

Emulsion of Chloroform, 359 

Emulsion of Cod liver oil, 
456 

Emulsion of Cod liver oil with 
Hypophosphites, 456 

Emulsions, 7, 5 

Emulsum Olei Morrhuae cum 
Hj-pophosphitibus, 456 

Encephalopathia saturnina, 
563 

Enemata, 173 

Enemata, cathartic, 173 

Enemata, nutritive, 173 

Enemose, 451 

Enzymes, 11 

Epinephrine, 240 

Epispastics, 26 

Epsom salt, 166 

Ergot, 478 

Ergot, Appearance of patient, 
478 

Ergotin, 483 

Ergotole, 483 

Ergot poisoning, 481 

Ergotinine citrate, 483 

Ergotoxine, 483, 478, 246 

Ericin, 524 

Eriodictyon, 644 

Ernutin, 483 

Errhines, 26 

Erythrol tetranitrate, 258 

Erythroxylon coca, 433 

Escharotics, 26, 631 

Eserine, 404, 163, 253 

Eserine salicylate, 408 

Eserine sulphate, 408 

Essence of pepsin, 129 

Essential oils, 11 

Essential salt of lemon, 113 

Ether, 346 

Ether, administration of, 352 

Ether anaesthesia, 347 

Ether, Appearance of patient, 
347 

Ether, Bromide of, 360 

Ether, Chloride of, 361 

Ether collapse- -'^-=;i 

Ether, comparison oi <i.f"ion 
with Chloroform, 3Cf 



INDEX 



663 



Ether, Compound spirits of, 

354 
Ether, dangers of, 351 
Ether poisoning, 351 
; Ethyl bromide, 360 
Ethj'l carbamate, 378 
Ethyl chloride, 361, 446 

Ethylenediamine tricresol, 
591 
' Ethylhydrocupreine, 500 
t Ethylhydrocupreine hydro- 
chloride, 500 
. Ethyl salicylate, 524 

Eucaine, 440 

Eucalyptol, 616, 615 

Eucalyptus, 615, 271, 136 

Eucalyptus, Oil of, 617 

Eucodein, 319 

Eudoxin, 611 

Eunatrol, 404 

Euonymus, 152 

Eupatorium, 403 

Eupthalmine, 440 

Euquinine, 499 

Euresol, 600 

Europhen, 610 

Euscopole, 423 

Evacuants, 27 

Exalgine, 390 

Examples of calculating doses 
from a limited number 
of tablets, 64 

Examples of calculating doses 
from stock solutions, 65, 
76 

Examples of calculating 
stronger doses from stock 
solutions, 72, 66, 76 

Examples of calculating 
weaker doses from stock 
solutions, 68, 66, 76 

Examples of calculating doses 
from stock tablets, 63 

Examples of fluid prescrip- 
tions, 649 

Examples of making solu- 
tions from stock solu- 
tions, 49, 59 

Examples of making solutions 
from powders, 47, 58 

Examples of making solutions 
from tablets, 45, 55, 
58 

Examples of making weak 
solutions from strong 
ones, 49, 59 

Examples of reducing Apothe- 
caries' quantities to their 
Metric equivalents, 35 

Examples of reducing Metric 
quantities to their 
Apothecaries' equiva- 
lents, 34 

Examples of solid prescrip- 
tions, 651 

Excito motors, 26 

Excretion, 12 

Exodyne, 391 

Exophthalmic goitre, 544 

Exophthalmos, 544 

Expectorants, 267, 270, 26 

Expectorants, sedative, 270 



Expectorants, stinmlating, 

267 
Extract of Belladonna, 417 
Extract of Digitalis, 227 
Extract of Nux Vomica, 302 
Extract of Opium, 316 
Extract of Witch hazel, 578 



Fats, 455, 449 

Febrifuges, 27 

Fel bovis, 152 

Fennel, 645 

Fermentation, 331 

Fermented liquors, 341 

Ferments, 11 

Ferratin, 201 

Ferrichthyol, 598 

Ferri et Potassii tartaras, 198, 

199 
Ferri et Quininae citras, 198 
Ferri et Strychninae citras, 

198 
Ferri hydroxidum cum Mag- 

nesii oxido, 200 
Ferri subsulphatis, 197 
Ferri sulphas, 197 
Ferro mangan, 201 
Ferropyrine, 388 
Ferro sajodin, 515 
Ferrous lactate, 201 
Ferrum, 194 
Fever, cause of, 383 
Fibrillation, 215 
Fibrin, 192 
Fibrin ferment, 192 
Fibrinogen, 192 
Fibrolysin, 632 
Filicic acid, amorphous, 178 
Filix mas, 177 
Filmaron, 178 
Fixed oil, 10 
Flavoring substances, 641, 

23 
Flaxseed, 635 
Flaxseed meal, 635 
Flexible collodion, 640 
Flowers of sulphur, 150 
Fluidextract of Belladonna, 

417 
Fluidextract of Digitalis, 227 
Fluidextract of Ergot, 482 
Fluidextracts, 5 
Fluid preparations of drugs, 4 
Foeniculum, 645 
Food principles, 449 
Food proteins, 539 
Formaldehyde, 582 
Formaldehyde poisoning, 582 
Formalin, 583 
Formation of blood, 187 
Formin, 622 
Formulary, 8 
Fothergill's pill, 472, 230 
Fowler's solution, 208 
Frangula, 153 
Friar's balsam, 619 
Fruit sugar, 454 
Fuller's earth, 636 
Function of stomach, 103 



Galactogogues, 27 

Galenical preparations of 
drugs, 2 

Galla, 576 

Gall and Opium ointment, 
577 

Gallic acid, 576, 114 

Gallogen, 576, 572 

Gall oak, 576 

Gallotannic acid, 572 

Gambir, 577 

Gamboge, 171 

Gambogia, 171 

Garden lettuce, 323 

Gas ether method of anaes- 
thesia, 353 

Gas oxygen anaesthesia, 365 

Gastric stimulants, 133 

Gaultheria, 642, 522 

Gelatine, 452 

Gelatine, glycerinated, 453 

Gelatine tannate, 575 

Gelatinose silver, 559 

Gelsemenine, 426 

Gelsemine, 426 

Gelsemium, 426 

Gelsemium poisoning, 427 

General anaesthesia, 347 

General anaesthetics, 346 

General cerebral depressants, 
324, 304 

General effects of drugs, 12, 

85 
Genito urinary antiseptics, 

618 
Gentian, 134 
Germicides, 581 
Gin, 341 
Ginger, 138 

Glacial Acetic acid, 111, 633 
Glandulae Suprarenalis sic- 

cae, 244 
Glandulae Thyroidae siccae, 

545 
Glauber's salt, 165 
Glonoin, 256 
Glonoin, Spirits of, 256 
Glucose, 454 
Glucosides, 10 
Glucosides of Digitalis, 219 
Glycerine, 149, 639 
Glycerite of Egg yolk, 639 
Glycerite of Phenol, 590 
Glycerite of starch, 639 
Glycerite of Tannic acid, 574 
Glycerites, 6 
Glyceritum amyli, 639 
Glyceritum boroglycerini, Ci4 
Glyceritum viteUi, 639 
Glycerole of Lecithin, 457 
Glycerophosphates, 462 
Glycerophosphoric acid, 462 
Glyco thymoline, 614 
Glycyrrhiza, 635, 162, 270 
Glycyrrhizin, 635, 162, 270 
Goa powder, 632 
Gold, 462 
Golden seal, 484 
Gonococcus vaccine, 536 
Gossypium, 490 



664 



INDEX 



Goulard's extract, 564 

Gout, 526 

Grain, 32 

Grain-to-ounce method of ex- 
pressing strengths of 
solutions, 41 

Gramme, 31 

Granatum, 179 

Grape juice, 112 

Grave's disease, 544 

Gray powder, 155, 507 

Green hellebore, 251 

Griffith's mixture, 200 

Grindelia, 270, 253 

Guarana, 296 

Guiacol, 617 

Guiacol carbonate, 618 

Guiacol cinnamate, 618 

Guiacol salol, 618 

Guiac resin, 463 

Guiajasanol, 618 

Guiamar, 618 

Gum arable, 634 

Gunjah, 321 

Guy's pills, 472, 230 

Gynoral, 393 

Gypsum, 640, 419 



H 

Haemaboloids, 202 

Haematinics, 187 

Haemogallol, 201 

Haemoglobin of the blood, 
function of, 187 

Haemostatics, 27 

Hallucinations, nature of, 285 

Hamamelis, 578 

Harrison law, 653 

Hashish, 321 

Headache powders, ingredi- 
ents of, 389 

Heart, action of, 211 

Heart action, conditions in- 
fluencing it, 215 

Heart depressants, 247, 253, 
17 

Heart depression, effects of, 
217 

Heart, effect of Vagus im- 
pulses on, 215 

Heart, inhibitory impulses of, 
215 

Heart, poisonous effects on, 
218 

Heart block, 214, 226 

Heart stimulants, 218, 17 

Heart stimulation, 216 

Hedonal, 380 

Hegonon, 560 

Helleborus niger, 219 

Helmitol, 622 

Henbane, 420 

Heroin, 320 

Heroin hydrochloride, 321 

Hexalet, 622 

Hexamethylenamine salioyl- 
as, 622 

Hexamethylenamine, 621 

Hoffman's anodyne, 394, 354 

Holadin, 131 



Holazone, 605 

Holocain, 442 

Holocain hydrochloride, 442 

Homatropine, 418 

Homatropine hydrobromide, 

419 
Hook worms, 185 
Hops, 395, 270 
Horehound, 644 
Hormonal, 163 
Hormone action, 11, 163 
Hormones, 11 

Household measurements, 33 
Humulus, 395 
Humulue lupulus, 395 
Hunjadi janos, 168 
Hunjadi water, 168 
Hydracetine, 391 
Hydragogue cathartics (sa- 
line purgatives), 153 
Hydragogues, 153, 27 
Hydrargyri benzoas, 509 
Hydrargyri chloridum oor- 

rosivum, 603, 592, 507 
Hydrargyri chloridum mite, 

154, 507, 472, 184 
Hydrargyri cyanidum, 593 
Hydrargyri iodidum flavum, 

508 
Hydrargyri iodidum rubrum, 

508 
Hydrargyri nucleinas, 509 
Hydrargyri oxycyanidum, 

593 
Hydrargyri salicylas, 509 
Hydrargyri subsulphas flaviis, 

146 
Hydrargyri succinimidum, 

509 
Hydrargyrum, 501 
Hydrastine, 485, 484 
Hydrastinine, 486 
Hydrastinine hydrochloride, 

487 
Hydrastis, 484 
Hydrobromic acid, 329 
Hydrochloric acid, 107, 104 
Hydrochloric acid poisoning, 

105 
Hydrochloric acid poisoning, 

treatment of, 106 
Hydrocyanic acid, 448, 266 
Hydrocyanic acid poisoning, 

447 
Hydrogen dioxide, 607 
Hydrogen peroxide, 606 
Hydroquinone, 600 
Hyoscine, 421, 410, 420 
Hyoscine hydrobromide, 423 
Hyoscyamine, 420, 410, 419 
Hyoscyamus, 420 
Hyoscyamus niger, 409 
Hyperpituitarism, 547 
Hyperthyroidism, 543 
Hypertonic salt solution, 189 
Hypnone, 380 
Hypnotics, 366 
Hypodermic administration, 

87 
Hypodermic injection, meth- 
od of administration, 87 
Hypodermoclysis, 191 



Hypophosphites, 461 
Hypophosphorous acid, 461 
Hypophysis sicca, 549 
Hypopituitarism, 548 
Hysteria, 392 



Iceland moss, 135 
Ichthalbin, 598 
Ichthargan, 560, 598 
Ichthoform, 598 
Ichthyol, 597 
Idiosyncrasy, 74 
Igasuric acid, 297 
Illusions, nature of, 285 
Illustration of hypodermic 
administration, opposite, 
70 
Imagination, nature of, 278 
Immunity, nature of, 532 
Immunization, active, 532 
Immunization, passive, 532 
Incompatibility, 80, 202 
Indian hemp, 321 
Indian poke, 251 
Indian tobacco, 430 
India rubber, 640 
Infusion of Digitalis, 227 
Infusion of Juniper, 471 
Ingluvin, 131 
Inhibition, nature of, 279 
Inhibitory impulses of the 

heart, 215 
Injections, method of admin- 
istration, 85 
Inorganic acids, 104 
Inorganic Iron preparations, 

198 
Inscription, 646 
Intestinal antiseptics, 615 
Intestinal stimulants, 147 
Intramuscular administra- 
tion, 86 
Intramuscular injection, 

method of giving, 86 
Intratracheal insufflation, use 
of in Morphine poison- 
ing, 313 
Intravenous infusion, 86, 190 
Intravenous injection, meth- 
od of administration, 86 
lodalbin, 515 
Iodides, 510 

Iodides, cumulative symp- 
toms, 513 
Iodides, poisonous effects of, 

513 
Iodides, specific action in 

Syphilis, 510 
Iodine, 594 
Iodine ointment, 596 
Iodine poisoning, 595, 513 
lodipin, 515 
lodism, 513, 595 
lodo casein, 515 
Iodoform, 608 
lodoformogen, 610 
Iodoform ointment, 609 
Iodoform poisoning, 608 
lodol, 609 



INDEX 



665 



lodophene, 391 

lodum, 594 

Ion action, 89, 324 

Ions, 89, 324 

lothion, 516 

Ipecac, 141, 404 

Ipecac, preparations of, 143 

Ipecacuanha, 141, 404 

Irish moss, 636 

Iron, 194 

Iron, administration of, 196 

Iron and Potassium tartarate, 
199 

Iron and Quinine citrate, 198 

Iron and Strychnine citrate, 
198, 303 

Iron, Appearance of patient, 

195 
Iron chloride, 197 

Iron hydroxide, 200 
Iron hydroxide with Mag- 
nesia oxide, 200 
Iron hypophosphite, 461 
Iron, incompatibilities of, 202 
Iron, inorganic preparations 

of, 198 
Iron, organic preparations of, 

201 
Iron subsulphate, 197 
Iron sulphate, 197, 592 
Iron tropon, 201 
Irritability of heart muscle, 

212 
Irritant diuretics, 470 
Irritants, 15, 623 
Irritation, 15 
Isopral, 380 
Isotonic solution, 189 
Itrol, 560 



Jaborandi, 398 
Jalap, 170 

Jamestown weed, 419, 426 
Japaconitine, 247 
Javelle's solution, 586 
Jerusalem oak, 185 
Jesuit's drops, 619 
Judgment, nature of, 278 
Juniper, 470, 643 
Juniper berries, 470, 643 



K 

Kali jodatum (Potassium 
Iodide) , 514 

Kalium (Potassium) com- 
pounds, 121, 165 

Kalium (Potassium) salts, 
121, 165 

Kamala, 180 

KaoUn, 636 

Kaolinum, 636 

Kefir fungus, 453 

Kephalin, 193 

Kidney stimulants, 406 

Kilogramme, 31 

Kino, 578 

Kinotannic acid, 572 



Kirchwasser, 343, 140 
Knockout drops, 369 
Kola, 292 
Kousso, 178 
Krameria, 577 
Kresamine, 591 
Kummel, 140 
Kumyss, 453 



Labarracque's solution, 586 
Lac bismo, 569 
Lactampoule, 537 
Lactic acid, 112 
Lactic acid bacilli, 537 

Lactic bacillary tablets, 537 

Lactophenine, 390 

Lactucarium, 323 

Ladies' slipper, 396 

Lady Webster's dinner pill, 
160 

Lamellae, 4 

Lanolin, 637 

Lapactic pills, 160 

Lard, 637 

Latin terms used in orders, 
647 

Latin terms used in prescrip- 
tions, 647 

Laudanum, 317 

Laughing gas, 363 

Lavandula, 642 

Lavender, 642 

Laxatives, 149 

Laxol, 157 

Lead, 562 

Lead acetate, 564 

Lead colic, 563 

Lead iodide, 565 

Lead paralysis, 563 

Lead plaster, 565 

Lead poisoning. Acute, 556 

Lead poisoning. Chronic, 562 

Lead poisoning, treatment of, 
564 

Lead subacetate solution, 565 

Least common denominator 
method of calculating 
doses, 68 

Lecibrin, 457 

Lecithin, 456 

Lecithol, 457 

Lemonade, 112 

Lemon juice. 111 

Lemon peel, 645 

Leptandra, 152 

Leucocyte extract, 538 

Levant wormseed, 181 

Levulose, 454 

Licorice, 635, 162, 271 

Licorice root, 635, 162, 271 

Liebig's meat juice, 449 

Light magnesia, 165, 126 

Lily of the valley, 230 

Lime, 122 

Lime and soda, 593 

Lime liniment, 125 

Lime water, 134, 185 

Limonis cortex, 645 

Liniments, 7, 83 



Linimentum calcis, 125 
Linimentum camphorae, 234 
Linimentum chloroformi, 360 
Linimentum saponis, 234 
Linseed, 635 
Linseed oil, 638 
Linum, 635 
Liqueurs, 343 
Liquid albolene, 151, 637 
Liquidamber orientalis, 620 
Liquid extract of Ergot, 484 
Liquid Peptonoids, 451 
Liquid petrolatum, 151, 637 
Liquid Thiol, 599 
Liquor Acidi arsenosi, 208 
Liquor Ammonii acetatis, 238 
Liquor Ammonii anisatus, 

268 
Liquor Antisepticus, 614 
Liquor Arseni et Hydrargyri 

iodidi, 208, 508 
Liquor Calcis, 124 
Liquor Chlori Compositae, 

586 
Liquor Cresolis Compositus, 

591 
Liquor Digitoxin Solubilis, 

227 
Liquor Ferri et Amonii ace- 
tatis, 199 
Liquor Ferri subsulphatis, 
197 

Liquor Ferri tersulphatis, 199 

Liquor Formaldehydi, 583 

Liquor hypophysis, 549 

Liquor lodi Compositus, 596 

Liquor Magnesii citratis, 167 

Liquor Potassii arsenitis, 20S 

Liquor Sodae chlorinatae, 586 

Liquor Sodii arsenitis, 208 

Liquor Sodii hydroxidi, 118 

Listerine, 614 

Lithium, 126 

Lithium benzoate, 476, 619 

Lithium bromide, 329 

Lithium carbonate, 476 

Lithium citrate, 476 

Lithium salts, 476 

Liver of Sulphur, 597 

Lobelia, 430, 253, 271 

LobeUa poisoning, 430 

Lobeline, 430 

Local administration of drugs, 
81 

Local anaesthetics, 433 

Losophan, 586 

Lotio Hydrargyri flava, 509 

Lotio Hydrargyri nigra, 508 

Lozenges, 3 

L. Suprarenin synthetic, 245 

Lubrichondrin, 636 

Lugol's solution, 596 

Lumbrici, 176 

Lumbricides, 181 

Lunar caustic, 558 

Lupulin, 395 

Lupulus, 395 

Lutein, 552 

Lycetol, 527 

Lycopodium, 636 

Lysoform, 591 

Lysol, 591 



666 



INDEX 



M 

Magendie's solution, 319 
Magnesia, 126 
Magnesium oxide, 165, 126 
Magnesia usta, 126 
Magnesium citrate solution, 

167 
Alagnesium peroxide, 607 
Magnesium salts, 126, 165 
Magnesium sulphate, 166, 

444 
Malakine, 390, 525 
Malaria, 494 
Male fern, 177 
Malt, 127 
Maltine, 128 
Maltzyme, 128 
Mammarj^ extract, 553 
Mammarj^ substance, 553 
Mandragora, 424, 410 
Mandrake, 424, 410 
Manganese, 202 
Manna, 150 

Mannitol hexanitrate, 258 
MaiTubium, 271, 644 
Massa Hydrargj-ri, 157, 507 
Massolin, 537 
Materia Medica, 1 
Matico, 621, 477 
Matricaria, 136 
Matzoon, 453. 
Maximum dose of a drug, 

61 
May apple, 155 
McMunn's Elixir, 317 
Meadow saffron, 525 
Measurement of Apotheca- 
ries' units, 32, 34 
Measurement of jNIetric units, 

31, 34 
Meat extracts, 451 
]Meat juices, 450 
Medicinal foods. 449 
Medinal, 375 
Medulla oblongata, 272 
INIedulIa oblongata, action of, 

280 
Meltzer Auer method of 

anaesthesia, use of in 

treatment of INIorphine 

poisoning, 313 
Memorj-, nature of action, 

277 
iMental activities of the brain, 

276 
IMental activities of the brain, 

effect of depression on, 

290 
Mental activities of the brain, 

effect of stimulation on, 

287 
Mentha piperita, 641 
Mentha viridis, 642 
Menthol, 446 
Mercuriahsm, 505 
Mercurial ointment, 508 
Mercuric benzoate, 509 
Mercuric cyanide, 593 
Mercuric oxycyanide, 593 
Mercuric salicj^late, 509 
Mercuric succinimide. 509 



Mercuric sulphate ethylen- 
diamine, 593 

Mercurol, 509 

Mercury, 501 

Mercury, Biniodide of, 507 

Mercury poisoning, Acute, 
504 

Mercurj' poisoning. Chronic, 
505 

Mercurj' poisoning, treat- 
ment of, 504 

Mercurj', Protoiodide of, 507 

Mercurj% specific action of, 
in Syphilis, 503 

Mercur>^ with chalk, 155, 507 

Mergal, 509 

Mesotan, 524 

Mesothorium, 530 

Metals, 557, 21 

Methacetine, 391 

Method of administering va- 
pors, 102 

Method of changing per- 
centage strength of solu- 
tions to equivalent ratio 
strength, 41 

IMethod of expressing 

strengths of solutions, 38 

^Method of finding percentage 
strength of a solution, 39 

Method of finding ratio 
strength of a solution, 40 

Method of preparing weak 
solutions from strong 
ones, 49 

Method of peptonizing milk, 
130 

Methylal, 381 

]M ethyl alcohol, 343 

INIethylarbutin, 471 

Methyl Codeine Bromide, 
319 

Methylene bichloride, 362 

Methylene blue, 622, 501 

Methylis Salicylas, 523 

Methyl sahcylate, 523 

Methylthioninae hydrochlo- 
ridum, 622, 501 

Metric equivalents of Apoth- 
ecaries' units, 33 

Metric system, 29 

Metric table of Capacity, 30 

]Metric table of Length, 29 

Metric table of Volume, 30 

Metric table of Weight, 30 

Mezereum, 469 

Migrainin, 391 

Mild Mercurous chloride, 
154, 507, 472, 186 

JNIilk and lime, 125 

Milk and molasses enema, 
173 

Milk foods, 453 

Milk of Magnesia, 126 

Milk sugar, 149, 454, 645 

Milk weed, 230, 473 

Milligramme, 31 

Mineral acids, 104 

IMineral astringents, 557, 21 
Mineral oil, 151 
Minimum dose of a drug, 61 
Mistura Bismuthi, 569 



IMistura Cretae. 126 
Mistura Ferri Composita, 200 
Mistura Glycyrrhizae Com- 

positus, 318, 270 
Mistura Rhei et Sodae, 159 
Misturae, 7 
Mitigated caustic, 558 
IVIitigated Silver nitrate, 558 
Mixtures, 7 
Moccasin plant, 396 
Mode of action of heart, 211 
Mode of action of Nervous:' 

sj^stem, 284 
Molasses, 149 
JNIonk's hood, 247, 404 
jNIonobromated Camphor, 

329, 394 
IMonotal, 618 

Monoglycol salicylate, 525 
jMonohydrated Sodium car- 
bonate, 118 , 
Monsell's solution, 197 
Morphine, 305, 318, 366, 491, 

266 
Morphine, action of, 307 
JMorphine, Appearance of pa- 
tient, 306 
Morphine, Compound pow- 
der of, 319 
iSIorphine habit, 313 
Morphine hydrochloride, 319 
Morphine, Idiosyncrasies of, 

310 
Morphine meconate, 319 
Morphine poisoning. Acute, 

311 
Morphine poisoning, Chronic, 
313 ; 

Morphine poisoning, treat- 
ment of, 311 
IMorphine Scopolamine an- 
aesthesia, 422 
Morphine sulphate, 319 
JMorphine, simamary of ef 

fects, 310 
INIorphine, uses of, 315 
Moschus, 394 
Alotor depressants, 426 
Motor depression, effects of 

289 
Motor stimulants, 404 
Motor stimulation, effects of 

387 
Moulded Silver nitrate, 557 
Movements of the bowels 

mode of action, 147 
Mucilage of Acacia, 634 
Mucilages, 6 
Muriated tincture of Iron, 

199 
Muriatic acid (Hydrochloric 

acid), 107 
IMurphy saline, method of 

administration, 99, 191 
Muscarine, 403 
Muscular sense, mode of ac- 
tion, 275 
:\Iusk, 394, 240 
INIustard, 624, 145 
Mustard bath, 624 
Mustard, methods of applica 
tion, 624 



INDEX 



667 



Mustard paste, 624 
Mydriatics, 27 

Myocardial insufficiency, 226, 
224 

Myotics, 27 
Myristica, 645 
Myrosin, 625 
Myrrh, 580 
Myrrha, 580 
Myxoedema, 543, 544 



N 



Naphthalene, 615 
Naphthol, 615, 525, 186 
Naphthol benzoate, 615 
Naphthol salicylate, 615, 525 
Narcotics (Hypnotics), 366 
Narcotine, 306, 320 
National Formulary, 8 
Neoarsphenamine, 518 

Neosalvarsan, 518, 209 

Nerium, 219 

Nerve endings, depression of, 
292 

Nerve endings, stimulation 
of, 288 

Nerves, action of, 282 

Nerves, afferent, 282 

Nerves, efTerent, 282 

Nerves, stimulation of, 288 

Nervous system, mode of ac- 
tion, 284 

Nervous system, physiology 
of, 272 

Neurasthenia, 392 

Neurodine, 350 

Neuro Lecithin, 457 

Neuronal, 380 

New Tuberculin, 537 

Nicotine, 431 

914 (Neosalvarsan), 518, 209 

Nitrate of Silver, 557 

Nitrates, 473 

Nitric acid, 108, 104, 633 

Nitric acid poisoning, 105 

Nitric acid poisoning, treat- 
ment of, 105 

Nitrites, 253 

Nitroglycerine, 257 

Nitroglycerine, Appearance 
of patient, 253 

Nitroglycerine, cumulative 
symptoms, 25S 

Nitroglycerine, poisonous ef- 
fects, 256 

Nitrohydrochloric acid, 108 

Nitrohydrochloric acid poi- 
soning, 105 

Nitrous oxide anaesthesia, 
363 

Nitrous oxide gas, 363 

Nitrous oxide gas, adminis- 
tration of, 365 

Nitrous oxide gas, Appear- 
ance of patient, 363 

Nitrous oxide poisoning, 3C4 

Normal horse serum, 538 

Normal salt solution, 18S, 57 

Novargan, 560 

Novaspirin, 524 



Novatophan, 528 

Novocaine, 442 

Novocaine nitrate, 442 

Nuclein, 538 

Nutgail, 576, 572 

Nutgall ointment, 577 

Nutmeg, 645 

Nutritive enemata, 173 

Nutrose, 452 

Nux Vomica, 296, 135 

Nux Vomaca, Extract of, 302 

Nux Vomica poisoning, 300 

Nux Vomica, Tincture of, 302 



Oak gall, 576, 572 

Official preparations, 7 

Oil, Castor, 156 

Oil, Croton, 169 

Oil, fixed, 10, 101, 169 

Oil of Cade, 601 

Oil of Cajuput, 633 

Oil of Chenopodium, 181, 184 

Oil of Cloves, 643 

Oil of Copaiba, 620 

Oil of Erygeron, 621, 477 

Oil of Eucalyptus, 616 

Oil of Juniper, 471 

Oil of Pennyroyal, 489 

Oil of Sandalwood, 621, 477 

Oil of Sweet birch, 523 

Oil of Turpentine, 628, 472 

Oil of Vitriol, 107, 104 

Oil of Wintergreen, 522, 642 

Oil, fixed, 11 

Oil, volatile, 11 

Oils, 11 

Ointment of Belladonna, 419 

Ointment of Boric acid, 614 

Ointment of Chrysarobin, 631 

Ointment, Diachylon, 565 

Ointment of IVIercury, 508 

Ointment of Red oxide of 
Mercury, 508 

Ointment of Yellow oxide of 
Mercury, 508 

Ointments, 4 

Old tuberculin, 537 

Oleander, 219 

Oleate of Atropine, 418 

Oleates, 7 

Oleoresin of Aspidium, 178 

Oleoresins, 11, 6 

Oleum Betulae, 523 

Oleum Camphorae, 234 

Oleum Eucalypti, 616 

Oleum Gaultheriae, 522 

Oleum Gossypii seminis, 638 

Oleum Hedeomae, 489 

Oleum Lini, 638 

Oleum Morrhuae, 455 

Oleum Olivae, 152, 638 

Oleum Ricini, 156 

Oleum Santali, 621, 477 

Oleum Terebenthinae, 628, 
472 

Oleum Theobromatis, 638 

Oleum Tiglii, 169 

Olive oil, 152, 638 

Opium, 305, 366, 266 



Opium, action of, 307 
Opium, active principles of, 

306 
Opium, alkaloids of, 318, 306 
Opium, Appearance of pa- 
tient, 306 
Opium, Camphorated tinc- 
ture of, 317 
Opium habit, 313 
Opium, Idiosyncrasies of, 310 
Opium, Pills of, 316 
Opium poisoning, 311 
Opium poisoning, treatment 

of, 311 
Opium, summary of effects, 

310 
Opium, Tincture of, 316 
Opsonins, 536 
Optochin, 500 
Ordeal bean, 404 
Orexin, 135 

Organic acids, 109, 104 
Organic astringents, 572 
Organic Iron preparations, 

201, 197 
Organic remedies, 541, 21 
Organic Silver preparations, 

558 
Orthoform, 443 
Orthoform, New, 443 
Osmosis, 89, 12 
Ouabain, 229 
Ounce, 32 

Ovarian extract, 551 
Ovarian substance, 552 
Overdose of a drug, 61 
Overstimulation, effects of, 

15 
Overstimulation of Nervous 

system, effect of, 288 
Ovoferrin, 201 
Oxalic acid, 113 
Oxalic acid poisoning, 113 
Oxalic acid poisoning, treat- 
ment of, 113 
Oxaphor, 266 
Ox gall, 152 
Ox gall enema, 173 
Oxone, 607 
Oxycamphor, 266 
Oxygen, 265 
Oxygen bath salts, 608 
Oxygen, use of in Pneumonia, 

265 
Oxyntin, 107 
Oxytocics, 478, 27, 20 



Panama bark, 268 
Panase, 131 
Pancreatin, 129 
Pancreatized milk toast, 453 
Pankreon, 131 
Panopepton, 452 
Pantopon, 317 
Papain, 132 
Papaverine, 424, 306 
Papaverine hydrochloride, 

424 
Papaverine sulphate, 418 



668 



INDEX 



Papaver somniferum, 305 
Papayotin, 132 
Pai>ers, 4 
Papoid, 132 

Paraffin, 637 

Paraffin for films, 637, 638 

Paraffin oil, 151 

Paraform, 583 

Paraformaldehyde, 583 

Paraguay' tea, 292 

Paraldehyde, 376, 266 

Paramidophenol, 383 

Parasiticides (see Antiseptics 
and Anthelmintics) 

Paratb\Toid extract, 546 

Paratophan, 528 

Paregoric, 317 

Pareira, 135 

Parresine, 638 

Parilhn, 463 

Passive immunity, 532 

Pearson's solution, 208 

Pegnin, 129 

Pelletierine, 179 

Pellotine hydrochloride, 381 

Pental, 362 

PennjToyal, 489 

Pepo, 178 

Pepper, 138 

Peppermint, 641 

Peppermint spirits, 641 

Peppermint water, 641 

Pepsin, 128 

Peptone, 451 

Peptonized beef tea, 453 

Peptonized milk, 130 

Peptonized milk gruels, 453 

Peptonized milk toast, 453 

Peptonized oysters, 453 

Peptonizing powder, 130 

Percentage method of ex- 
pressing strengths of 
solutions, 39 

Peristaltic hormone, Zuelzer, 
163 

Perogen bath salts, 608 

Peronine, 320 

Peroxide of Hydrogen, 606 

Peruvian bark, 492 

Petrolatum, 637 

Petrolatum album, fi37 

Petrolatum liquidum, 637 

Pharmaceutical preparations, 
2 

Pharmacodj-namics, 1 

Pharmacognosj', 1 

Pharmacology-, 1 

Pharmacopoeia, 7 

Phenacetine, 389, 384, 491, 
323 

Phenacetine poisoning, 387 

Phenacetine urethane, 389 

Phenoco, 602 

PhenocoU, 390 

PhenocoU hydrochloride, 390 

PhenocoU salicylate, 390, 525 

Phenol, 587 

Phenol poisoning, 588 

Phenolphthalein, 162 

Phenylis salicylas, 523 

Phenyl sahcylate, 523 

Phenylcinchoninic acid, 528 



Phloridzin. 501 

Phosphorated oil. 461 

Phosphoric acid, 461 

Phosphorous, 45S 

Phosphorous poisoning. 

Acute, 458 

Phosphorous poisoning. 

Chronic, 460 

Phosphorous poisoning, treat- 
ment of, 459 

Phj-sical action of drugs, 12 

Ph%-sical chemistrj- of salts, 
88, 12 

Physical chemistrj- of solu- 
tions, 88 

Phj-sical preparations of 
drugs, 2 

Physiological action of drugs, 
14 

Phj-siological salt solution, 
189, 57 

Phj-siology of the blood, 187 

Phjsiology of blood clotting, 
192 

Phjsiologj- of the circulation, 
211 

Physiology of the heart, 211 

Physiologj- of the nervous 
s\-stem, 272 

Physostigma, 404 

Physostigmine, 404, 163, 293 

Physostigmine poisoning, 407 

Physostigmine salicylate, 408 

Physostigmine sulphate, 408 

Picric acid, 611 

Pill, Compound cathartic, 
172 

Pill, Lapactic, 160 

Pill of Aloes and Iron, 160, 
199 

Pill of Aloes and Mastiche, 
160 

Pill of Aloes and ^Ij-rrh, 160 

Pill of Iron carbonate, 198 

Pill of Iron iodide, 198 

Pill of Opium, 316 

Pill of Podophj^lum Bella- 
donna and Capsicum, 
156 

Pills, 3 

Pill, Vegetable cathartic, 172 

Pilocarpine, 398, 253 

Pilocarpine, Appearance of 
patient, 399 

Pilocarpine hvdrochloride, 
403 

Pilocarpine poisoning, 402 

Pilocarpine poisoning, treat- 
ment of, 402 

Pilocarpus, 398 

Pilulae Catharticae Com- 
positae, 172 

Pilulae Catharticae Vegeta- 
bilis, 172 

Pilulae Ferri Carbonatis, 198 

Pilulae Ferri iodidi, 198 

Pilulae Ferri jodatum (io- 
didi), 198 
Pilulae Laxativae Com- 

positae, 160 
Pimenta, 645 
Pink root, 182 



Pin point pupils, 311 
Pine tree, 600, 626 
Pinus palustris, 600. 620 
Piperazine, 527 
Piperazine quinnate, 527 
Pituitary- body, dessicated, 

549, 546 
Pituitary- extract, 245, 488 
Pituitrin, 488, 550 
Pix liquida, 600, 626 
Plant acids, 109, 104, 9 
Plasmine, 635 
Plaster, adhesive, 565 
Plaster, Belladonna, 417 
Plaster, Cantharides, 630 
I Plaster, Capsicum, 629, 138 
I Plaster of Paris, 640 
i Plasters, 4 
Plastic paraffin, 637, 638 
Pleasant emotions, nature of, 

278 
Plumbi acetas, 564 
Plumbism (Lead poisoning), 

562 
Plumbum, 562 
Pluto water, 168 
Pneumococcus vaccine, 536 
PodophyUin, 155 
Podophylum, 155 
Poisoning by AlkaUes, 116 
Poison mushrooms, 403 
Poison nut, 297 
Poisonous action of drugs, 14 
Poisonous dose of a drug, 61 
Pollen Extracts, 539 
Pollen vaccine, 539 
Pollantin, 538 
Poh-\-alent Antistreptococcus 

serum, 533 
Pomegranate, 179 
Porter, 343 
Port wine, 342 
Potash, 121 
Potash and hme, 122 
Potassa cum Calce, 122 
Potassium acetate, 475 
Potassium and Soditun tar- 

tarate, 165 
Potassium bicarbonate, 122 
Potassium bitartarate, 165, 

475 
Potassium bromide, 329 
Potassium carbonate, 121 
Potassium chlorate, 571 
Potassium chlorate poisoning, 

571 
Potassium chlorate poisoning, 

treatment of, 572 
Potassium citrate, 475, 404 
Potassium cyanide, 448 
Potassram hydroxide, 121, 

633 
Potassitmi hj-pophosphite, 

461 
Potassium iodide, 514 
Potassium iodide ointment, 

515 
Potassium nitrate, 474 
Potassium nitrite, 258 
Potassium oxalate, 113 
Potassium permanganate, 
607, 203 



INDEX 



669 



Potassium salts, 165, 121 
Potassium sulphate, 165 
Potato fly. 631 
Powdered Ipecac, 143 
Powdered Ipecac and Opium, 

316 
Powdered Opium, 316 
Powders, 3 

Predigested liquid food, 452 
Preparation of doses, 61 
Preparation of hypodermic 

doses, 63, 65 
Preparations for anaesthesia, 

352 
Preparations of Fats, 454 
Prepared lard, 637 
Prescription reading, 646 
Pride of China, 183 
Problems in calculating doses, 

57 
Problems in household 
weights and measures, 37 
Problems in reducing apoth- 
ecaries' quantities to 
metric equivalents, 37 
Problems in reducing metric 
quantities to apoth- 
ecaries' equivalents, 37 
Problems in solutions, 57 
Procaine, 442 
Procaine nitrate, 442 
Proferrin, 201 

Progressive cerebral depres- 
sants, 330, 304 
Propaesin, 444 
Prophylactics, 27 
Proportion method of cal- 
culating solutions, 45, 47 
Propyl Alcohol, 345 
Protan, 575 
Protargol, 559 
Protectives, 639 
Protein preparations, 450 
Proteins, 450 
Protein silver salt, 559 
Protoiodide of Mercury, 507 
Prunus Virginiana, 2Y0 
Prussic acid, 446, 266 
Pr-ussic acid poisoning, 447 
Pulvis, 3 
Pulvis Acetanilidi Composi- 

tus, 388 
Pulvis Aromaticus, 645 
Pulvis Effervescens Composi- 

tus, 166 
Pulvis Glycyrrhizae Composi- 

tus, 162 
Pulvis Ipecacuanhae, 143 
Pulvis Ipecacuanhae et Opii, 

310, 143 
Pulvis Morphinae Composi- 

tus, 319 
Pulvis Pancreaticus Com- 

positus, 130 
Pumpkin seeds, 180 
Purgatives, 153, 27 
Purgatives, Drastic, 168 
Purgatives, Saline, 163 
Purgatives, Vegetable, 155, 

149 
Purified extract of Ergot, 483 
Purple foxglove, 219 



Pustulants, 631 

Pyramidon, 389, 491, 323 

Pyramidon acid camphorate, 
389 

Pyramidon neutral campho- 
rated, 389 

Pyridine, 431 

Pyrocatechin, 600 

Pyrogallic acid, 600 

Pyrogallol, 600 



Quaker buttons, 296 

Quassia, 134, 185 

Quassin, 134 

Quebracho, 264 

Queen's delight, 465 

Quevenne's iron, 198 

Quicklime, 125 

Quicksilver, 501 

Quillaja, 268 

Quinidine, 492 

Quinine, 493, 498 

Quinine, action of, 493 
Quinine, administration of, 

497 
Quinine and Urea hydrochlo- 
ride, 499 
Quinine bisulphate, 498 
Quinine ethyl carbonate, 499 
Quinine hydrobromide, 498 
Quinine hydrochloride, 498 
Quinine, Idiosyncrasies of, 

496 
Quinine lygosinate, 500 
Quinine poisoning, 496 
Quinine, specific action in 

Malaria, 495 
Quinine sulphate, 498 
Quinine tannate, 499 
Quinolin Bismuth sulphocy- 
anate, 570 



Rabies Antitoxin (Antirabic 
vaccine), 538 

Radium, 529 

Radium emanation, 530 

Ratio method of expressing 
strengths of solutions, 40 

Reasoning power of the brain, 
mode of action, 276 

Rectoclysis, 99, 191 

Red corpuscles of the blood, 
function of, 187 

Red iodide of Mercury, 508 

Red rose petals, 579, 642 

Reduced iron, 198 

Red wines, 342 

Refined Diphtheria Anti- 
toxin, 535 

Reflex action, nature of, 282, 
280 

Refrigerants, 27 

Regulin, 151 

Rennet, 129 

Resin of Podophylum, 156 

Resinous cathartics, 175 



Resins, 11 

Resorcin, 599 

Resorcin monacetate, 600 

Resorcinol, 600 

Respiration, mechanism of, 

261 
Respiratory center of Medul- 
la, action of, 280 
Respiratory depressants, 266, 

17 
Respiratory stimulants, 264, 

17 
Respiratory stimulation, ef- 
fects of, 263 
Revulsants, 27 
Rhamnus purshianae, 153 
Rhatany, 577 
Rheum, 158 
Rhubarb, 158 
Rhubarb and Soda mixture, 

159 
Rhus glabra, 579 
Ringer's tablets, 190 
Ringer's solution, 190 
Rochelle salt, 165 
Rosa gallica petalae, 579, 642 
Rosemary, 643 
Rose ointment, 579, 642 
Rose water, 579, 642 
Round worms, 176 
Rubbings, 102 
Rubefacients, 624, 27, 22 
Rubus, 578 

Rule for calculating doses 
from stock solutions, 66, 
68 
Rule for calculating doses 

from stock tablets, 63 
Rule for calculating doses 
greater than that con- 
tained in a drop of stock 
solution, 72 
Rule for calculating doses less 
than that contained in a 
drop of stock solution, 
68, 66 
Rule for calculating the dose 

for a child, 73 
Rule for finding the per- 
centage strength of a 
solution, 39 
Rule for finding the quantity 
of water in which to dis- 
solve a tablet to make up 
a solution of a desired 
strength, 45 
Rule for finding the ratio 
strength of a solution, 40 
Rule for making solutions 
from crude substances, 
47 
Rule for making solutions 

from powders, 47 
Rule for making solutions 
from stock solutions, 49 
Rule for making solutions 

from tablets, 47 
Rule for preparing a number 
of doses from a limited 
number of stock tablets, 
64 
Rule for reducing Apotheca- 



670 



INDEX 



Ties' quantities to their 
Metric equivalents, 35 

Rule for reducing Metric 
quantities to their 
Apothecaries' equiva- 
lents, 34 

Rules for making solutions, 
45 

Rum, 341 

Russian Mineral Oil, 151 



Sabromin, 330 

Saccharin, 645 

Saccharum lactis, 645, 149 

Sacred bark (Cascara sa- 
grada), 153 

Sajodin, 515 

Sal Carohnum, 166 

Sal Carolinum fa +itimn, 166 

Saleratus (Potas ^ui^ bicar- 
bonate), 122 

Sal Ethyl, 524 

Salicin, 523 

Salicylates, 518 

Salicylates, poisonous effects, 
521 

Salicylates, specific action in 
Rheumatism, 520 

SahcyHc acid, 518 

Salicyhc acid ointment, 524 

Sahformin, 622 

Saliphen, 390, 525 

Sahpyrin, 388 

Saline Diuretics, 474 

Saline purgatives, 163, 149 

Saline purgatives, mode of ac- 
tion, 163 

Salines (salts). 111, 115, 474, 
324 

Salocoll, 390 

Salol, 523 

Salophen, 390, 524 

Saloquinine, 500, 524 

Saloquinine salicylate, 500, 
525 

Salt, 146 

Salt, acid radicle of, 324 

Salt action, 13, 89 

Salt, base of, 324 

Salt, Carlsbad, 166 

Salt, Epsom, 166 

Salt, Glauber, 165 

Salt, Rochelle, 165 

Sahpeter, 474 

Salts of Magnesium, 126, 165 

Salts of Potassium, 121, 165 

Salts of Sodium, 118, 165 

Salts, physical chemistry of, 
88, 12 

Salvarsan, 516, 200 

Sanatogen, 450 

Sandal wood oil, 621, 477 

Santonica, 181 

Santonin, 181 

Sanguinaria, 269, 324 

Saponins, 10 

Sarsaparilla, 463 

Sarsaparilla, Compound syr- 
up of, 463 



Sassafras, 464, 645 

Sassafras medulla, 635 

Saturated solution, 42 

Saturation points of solutions 
for external use, 43 

Saturation points of solutions 
for internal use, 44 

Saturation points of solu- 
tions, table of, 43, 44 

Scammonium, 172 

Scammony, 172 

Scarlet Red, 632 

Schleich's solution, 439 

Scilla, 229 

Scoparin, 470 

Scoparius, 470 

Scopola, 423, 410 

Scopolamine, 421 

Scopolamine hydrobromide, 
423 

Scuttelaria, 396 

Sea onion, 229 

Seat worms, 176 

Secretory- depressants, 409 

Secretor\- stimulants, 398 

Sedative Expectorants, 270 

Sedatives, 27 

Seidlitz powder, 166 

Selective action of drugs, 13 

Senega, 268 

Senegin, 268 

Senna, 161, 184 

Senna tea, 161 

Sense of hearing, mode of ac- 
tion, 274 

Sense of pain, mode of action, 
275 

Sense of sight, mode of action, 
273 

Sense of smell, mode of ac- 
tion, 274 

Sense of taste, mode of ac- 
tion, 274 

Sense of temperature, mode 
of action, 275 

Sense of touch, mode of ac- 
tion, 274 

Sera (serums)-, 522 

Serpentaria, 136, 271 

Serum sickness, 529 

Serums, 532, 21 

Serums, method of manufac- 
ture, 532 

Sevum praeparatimi, 637 

Sherr>% 342 

Sialogogues, 27 

Sidonal, 527 

Signature of a prescription, 
646 

Silver, 557 

Silver Casein, 560 

Silver ichthyolate, 560 

Silver lactate, 560 

Silver nitrate, 557, 633 

Silver nitrate Ammonia al- 
bumose, 560 

Silver nitrate poisoning, 557 

Silver oxide, 558 

Silver poisoning, 557 

Silver Proteinate, 560 

Silver vitellin, 559 

Simple bitters. 134 



Sinalbin, 625 

Sinapis, 624 

Sinapis alba, 624 

Sinapis nigra, 624 

Sinigrin, 625 

Sinus node, 213 

606 (Salvarsan), 516, 20S 

Skull cap, 396 

Slaked hme, 125 

Slippery elm, 634 

Smilacin, 463 

Smilax, 463 

Snake root, 268 

Soamin, 209 

Soap bark, 268 

Soap liniment, 234 

Soap plaster, 565 

Soda, 118 

Sodiiun acetate, 476 

Sodiinn arsenate, 209 

Sodium benzoate, 619 

SocUum bicarbonate, 119 

Sodium borate, 614 

Sodium bromide, 329, 324 

Sodium cacodylate, 209 

Sodium carbonate, 118 

Sodium chlorate, 572 

Sodium citrate, 192 

Sodium chloride, 146, 185 

Sodium compounds, 118 

Sodium Diethj'l Barbiturate. 
375 

Sodium hydroxide, 118, 633 

Sodium hj-pochlorite, 603 

Sodium hj-pophosphite, 461 

Sodium ichthyol, 598 

Sodium iodide, 515 

Sodium nitrate, 479 

Sodium nitrite, 258 

Sodium perborate, 600 

Sodium peroxide, 607 

Sodium phosphate, 165 

Sodiiun saUcylate, 522 

Sodium sulphate, 165 

Solid preparations, 2 

Solute, 38 

Solution of adrenalin chlo- 
ride, 551 

Solution of Ammonia and 

Anise, 268 
Solution of Anunonium ace- 
tate, 238, 404 
Solution of arsenious acid, 

208 
Solution of Arsenic and Mer- 

curous iodide, 208, 508 
Solution of brain extract, 193 
Solution of Calcium hydrate, 

124 
Solution of Chlorinated Soda, 

586 
Solution of Epinephrine hy- 
drochloride, 551 
Solution of Formaldehyde, 

582 
Solution of Hydrogen perox- 
ide, 603 
Solution of hypophysis, 549 
Solution of Iron and .Ajnmo- 

nium acetate, 199 
Solution of Lead subacstats, 
564 



INDEX 



671 



Solution of Magnesium cit- 
rate, 167 
Solution of Potassium arsen- 

ite, 208 
Solution of pituitary extract, 

550 
Solution of Potassium citrate, 

475 
Solution of sodium arsenite, 

208 
Solution of Sodium hydrox- 
ide, 118 
Solutions, 38, 5 
Solutions, rules for making, 

45 
Solutions, saturated, table of, 

43, 44 
Solutions, physical chemis- 
try of, 88 
Solutol, 592 
Solveol, 592 
Solvent, 38 
Somatose, 450 
Somnifacients, 366, 27 
Somnoform, 363 
Sophol, 560 
Soporifics, 366, 27 
Source of drugs, 1 
Sozal, 610 
Sozoiodol, 610 
Spanish fly, 630 
Sparkling Burgundy, 342 
Sparkling white wines, 342 
Sparteine, 429, 470 
Sparteine sulphate, 430 
Spearmint, 642 
Specifics, 492, 27, 20 
Specifics for amoebic dysen- 
tery, 529, 20 
Specifics for Gout, 526, 20 
Specifics for Malaria, 492, 20 
Specifics for Rheumatism, 

520, 20 
Specifics for Syphilis, 501, 

510, 516 
Speech impulses of the brain, 

276 
Spermacetti, 639 
Spigelia, 182 
Spinal anaesthesia, 445 
Spinal cord, action of, 280 
Spinal cord, effect of depres- 
sion of, 290 
Spinal cord, effect of stimu- 
lation of, 288 
Spinal cord stimulants, 292 
Spirit of Camphor, 234 
Spirit of Chloroform, 359 
Spirit of Ether, 353, 474 
Spirit of Glonoin, 257 
Spirit of Glyceryl trinitrite, 

257, 404 
Spirit of Mindererus, 238 
Spirit of Nitroglycerine, 257 
Spirit of Nitrous ether, 259, 

404, 474, 354 
Spirits, 6 
Spiritus Aetheris nitrosi, 259, 

404, 474, 354 
Spiritus Frumenti, 340 
Spiritus Glycerylis nitratis, 
257 



Spiritus Menthae piperitae, 

641 
Spiritus Rosemarini, 643 
Spiritus vini gallici, 340 
Spirosal, 525 
Spotted hemlock, 428 
Squibb 's diarrhoea mixture, 

318, 479 
Squills, 229, 472, 271 
Squirting cucumber, 170 
Stanolind surgical wax, 638 
Staphisagria, 251 
Staphylococcus vaccine, 536 
Starch, 635 
Starch enema, 173 
Starch svigar, 454 
Stavesacre, 251 
Stearoptene, 11 
Sterules, 4 
Stillingia, 465 
Stimulants, 15 
Stimulants of motor nerve 

endings, 404 
Stimulants of nerve endings, 

397 
Stimulants of secretory nerve 

endings, 398 
Stimulating expectorants, 267 
Stimulation, 15 
Stimulation of blood-forming 

organs, effects of, 188 
Stimulation of medulla ob- 
longata, effects of, 287 
Stimulation of motor areas of 

brain, effects of, 286 
Stimulation of speech center 

of brain, effects of, 286 
Stock vaccines, 535 
Stomachics, 28 
Stokes' Expectorant, 230 
Storax, 619 
Stout, 343 
Stovaine, 443 
Stramonium, 419 
Streptococcus vaccine, 536 
Strontium bromide, 329 
Strontium iodide, 515 
Strontium lactate, 476 
Strontium peroxide, 607 
Strophantin, 229 
Strophantus, 228 
Strychnine, 296, 239, 264 
Strychnine, Appearance of 

patient, 297 
Strychnine, cumulative poi- 
soning, 301 
Strychnine poisoning. Acute, 

300 
Strychnine poisoning, Chron- 
ic, 301 
Strychnine, poisoning, treat- 
ment of, 301 
Strychnine sulphate, 302 
Styptic collodion, 640, 564 
Stypticin, 487 
Styptics, 28 
Styptol, 487 
Styracol, 618 
Styrac, 619 
Subconscious actions, nature 

of, 282 
Sublamine, 593 



Sublimed sulphur, 150 
Subnitrate of Bismuth, 569 
Substances which improve 

nutrition, 449 
Succinic dioxide, 607 
Sudden Chloroform death, 

357 
Sudorifics, 28 
Suet, 637 
Sugar of lead, 564 
Sugar of milk, 645, 149 
Sulphaminol, 610 
Sulphonal, 372, 266 
Sulphonal, cumulative symp- 
toms, 373 
Sulphonal poisoning, 373 
Sulphur, 150, 596 
Sulphur dioxide, 584 
Sulphuric acid, dilute, 108 
Sulphuric acid poisoning, 105 
Sulphur iodide, 596 
Sulphur ointment, 597 
Sulphur sublimatum, 567, 150 
Sumach, 579 
Sumbul, 396 
Summary of administration 

of remedies, 100 
Summary of calculation of 

doses, 74 
Summary of cathartics, 174 
Summary of solutions, 55 
Supersaturated solution, 42 
Supersaturation point, 42 
Superscription, 646 
Suppositories, 4 
SupracapsuUn, 245 
Suprarenalin, 245 
Suprarenin, 245 
Surgical paraffin, 637, 638 
Surgical solution of chlorin- 
ated soda, 604 
Sweet almonds, 635 
Sweetening substances, 645 
Sweet orange peel, 641 
Sweet red wines, 342 
Sweet spirit of Niter, 259, 

404, 474, 354 
Sweet wines, 341 
Swift Ellis method of admin- 
istering Salvarsan, 517 
Sympathetic nervous system, 

mode of action, 281 
Synergistic action, 14 
Syphilis, 503 • 
Syrup of Calcium hydroxide, 

124 
Syrup of Hydriodic acid, 515 
Syrup of Iodide of Iron, 199 
Syrup of Ipecac, 144 
Syrup of Iron, Quinine and 
Strychnine phosphate, 
200, 303, 499 
Syrup of lime, 124 
Syrup of Rhubarb, 158 
Syrup of Senega, 268 
Syrup of Squills, 230 
Syrup of Tolu, 269 
Syrup of wild cherry, 270 
Syrups, 6 

Sj'rupus Calcis, 602, 124 
Syrupus Ferri jodatum (io- 
didi), 199 



672 



INDEX 



Syrupus Hypophosphitum, 

462 
Syrupus Hypophosphitum 

Compositus, 462 
Syrup of Hypophosphite, 462 
Syrupus Pruni Virginianae, 

270 
Syrupus Tolutanus, 270 
Systemic action, 11, 85 
Systems of weights and 

measures, 29 



Tabacum, 431 

Tabellae Trinitri, 258 

Table of administration of 
remedies, 100 

Table of Apothecaries' equiv- 
alents of Metric units, 33 

Table of Apothecaries' fluid 
measurement, 32 

Table of Apothecaries' 
Weights, 32 

Table of Approximate Metric 
units used in prescrip- 
tions, 36 

Table of Circulatory Stimu- 
lants, 246 

Table of Metric lengths, 30 

Table of Metric volumes, 30 

Table of Metric weights, 30 

Table of Usual strengths of 
solutions for external use, 
56 

Table of Usual strengths of 
solutions for internal use, 
75 

Tables of cathartics, 174 

Tablets, 3 

Taeniae, 176 

Taenicides, 177 

Taka diastase, 128 

Talcum, 636 

Tamarind, 150 

Tamar Indien (Confection of 
Senna), 161 

Tanacetum, 481 

Tannacol, 575 

Tannalbin, 575 

Tannic acid, 572, 185 

Tannic acid ointment, 574 

Tannigen, 575 

Tannin albuminate, 575 

Tanninformaldehydum, 554 

Tannin nucleo protein, 554 

Tannin, 572 

Tannins, 11 

Tannismuth, 570 

Tannoform, 575 

Tannopin, 575 

Tannon, 575 

Tannyl acetate, 575 

Tape worms, 176 

Tar, 600 

Taraxacum, 135 

Tartar emetic, 146 

Tartaric acid, 112 

Tea, 292 

Tea plant, 579 

Temperature, mode of pro- 
duction, 383 



Temperature, mechanism of 
reduction, 383 

Temperature, Mechanism of 
regulation, 384 

Terebene, 629 

Terebenum, 629 

Terebinthina, 626 

Terpin, hydrate, 269 

Terpin hydras, 269 

Tetanus Antitoxin, 535 

Tetranitrol, 260 

Tetronal, 376, 266 

Thallein acetate, 426 

Thalline, 390 

Thebaine, 306 

Theobroma, 467 

Theobromine, 467 

Theobromine and Lithium 
benzoate, 469 

Theobromine and Lithium 
salicylate, 469 

Theobromine Sodium acetate, 
469 

Theobromine Sodium sali- 
cylate, 469 

Theocin, 469 

Theophylin, 469 

Theophylin Sodium acetate, 
469 

Therapeutic action, 14 

Thermodin, 389, 390 

Thiersch powder, 523, 603 

Thiersch solution, 523, 603 

Thilanin, 597 

Thioform, 611 

Thiol, 598 

Thiolum, 598 

Thiophene, 610 

Thiosinamine, 632 

Thiosinamine Sodium sali- 
cylate, 632 

Thorium, 530 

Thorn apple, 419 

Thoroughwort, 403 

Thread worms, 176 

Thrombin, 192 

Thrombokinase, 192 

Thromboplastic substances, 
193 

Thromboplastin, 192 

Thromboplastin solution, 193 

Thujon, 231 

Thymacetine, 391 

Thymol, 185, 616 

Thymolis iodidum, 610 

Thymosalol, 525 

Thymus extract, 552 

Thyroid extract, 543 

Thyroid gland, 550 

Thyroidectin, 545 

Thyroxin, 543 

Time of administration of 

remedies, 92, 100 
Tinctura Benzoini Com- 

posita, 619 
Tinctura Cinchonae Com- 

posita, 492 
Tincture of Aconite, 250 
Tincture of Arnica, 629 
Tincture of Belladonna, 

417 
Tincture of Benzoin, 619 



Tincture of Benzoin, Com- 
pound, 619 
Tincture of Cannabis Indica, 

323 
Tincture of Cantharides, 630 
Tincture of Cinchona, 498 
Tincture of Cinchona, Com- 
pound, 498 
Tincture of Deodorized Opi- 
um, 317 
Tincture of Digitalis, 227 
Tincture of Guiac, 464 
Tincture of Hyoscyamus, 420 
Tincture of Iodine, 596 
Tincture of Iron chloride, 199 
Tincture of Myrrh, 580 
Tincture of Nux Vomica, 302 
Tincture of Opium, 317 
Tincture of Opium, Cam- 
phorated, 317 
Tincture of Valerian, 393 
Tobacco, 431 
Tobacco camphor, 431 
Tone of heart muscle, 213 
Tonics, 187, 28 
Tragacanth, 634 
Transfusion, 191 
Treatment of Atropine poi- 
soning, 415 
Treatment of Carbolic acid 

poisoning, 589 
Treatment of Hydrocyanic 

acid poisoning, 448 
Treatment of Opium poison- 
ing, 312 
Treatment of poisoning by 

acids, 106 
Treatment of poisoning by 

alkalies, 117 
Trichloracetic acid. 111, 633 
Tricresol, 591 
Triferrin, 201 

Trinitrin (Nitroglycerin), 257 

Trional, 375, 266 

Trioxy methylene, 583 

Triphenin, 390 

Triticum, 472 

Troches (Lozenges), 3 

Trochisci, 3 

Tropacocaine, 441 

Tropacocaine hydrochloride, 
441 

Tropical fruit laxative (Con- 
fection of Senna), 161 

Trypsin, 131 

Tuberculin, 537 

Tuberculin, New, 537 

Tuberculin, Old, 537 

Tully's powder, 319 

Tumenol, 599 

Tnmenol Ammonium, 599 

Tumenol Venale, 599 

Turlington's balsam, 619 

Turpentine, 626, 472, 271, 
178 

Turpentine liniment, 628 

Turpentine oil, 628, 472 

Turpentine stupe, 628 

Turpeth mineral, 146 

Tussol, 388 

Twilight sleep, 422 

Types of drug action, 12 



INDEX 



673 



Typhoid vaccine, 536 
Tyramine, 483 



U 

Ulmus, 634 

Uncinaria Americana, 185, 

176 
Uncinariae, 176, 185 
Unguentum, 3, 4, 637 
Unguentum Acidi Borici, 614 
Unguentum Aqua Rosae, 

579, 642 
Unguentum Cred6, 559 
Unguentum Diachylon, 565 
Unguentum Gailae cum Opii, 

577 
Unguentum Hydrargyri, 508 
Unguentum Hydrargyri am- 

moniati, 508 
Unguentum Hydrargyri ni- 

tratis, 508 
Unguentum Hydrargyri oxidi 

jflavi, 508 
Unguentum Hydrargyri oxidi 

rubri, 508 
Unguentum lodi, 596 
Unguentum lodoformi, 609 
Unguentum Sulphuris, 597 
Unguentum Zinci Oxidum, 

566 
Unguentum Veratrinae, 252 
United States Dispensatory, 

8 
Unofficial preparations, 7 
Unslaked lime, 125 
Untoward effect, 14 
Upas tree, 219 
Urari, 431 
Urethane, 378 
Urinary Antiseptics, 618 
Urophen B, 469 
Urophen S, 469 
Urotropin, 621, 477 
Uterine Depressants, 490 
Uterine Sedatives, 490, 20 
Uterine Stimulants, 478, 20 
Uva Ursi, 471 



Vaccines, 532, 533 
Vaccines, Bacterial, 532 
Vaccine virus, 538 
Vagus center of the Medulla, 

280 
Vagus center, depression of, 

290 
Vagus center, stimulation of, 

287 
Valentine's meat juice, 449 
Valerian, 392 
Validol, 393 

Validol camphorate, 393 
Valyl, 393 
Vanilla, 644 
Vascular depressants, 253, 

473 
Vascular sedatives, 253, 473 
Vascular stimulants, 240 



Vaseline, 637 
Vaso constrictors, 240 
Vaso dilators, 253, 473 
Vaso-motor center of the 

Medulla, 280 
Vegetable acids, 109 

Vegetable astringents, 572 

Vegetable cathartic pill, 172 

Vegetable cathartics (Simple 
Purgatives), 154 

Vegetable diuretics (Irritant 
diuretics), 470 

Vegetable purgatives, 154 

Vegetable substances con- 
taining GaUic acid, 576 

Vegetable substances contain- 
ing Tannic acid, 576 

Vehicle of a prescription, 647 

Ventricular fibrillation, 215 

Veratrine, 252, 251 

Veratrine effect, 252 

Veratrine ointment, 252 

Veratrum, 251, 404 

Veratrum poisoning, 252 

Veratrum sabadilla, 252 

Veratrum viride, 251, 404 

Vermicides, 196 

Vermifuges, 176 

Veroform, 602 

Veronal, 374, 266 

Veronal Sodium, 374 

Vescettes, 3 

Vesicants, 629, 28, 22 

Vesicating collodion (Can- 
tharides collodion), 630 

Vesicatories, 28 

Viburnum, 490 

Viburnum opulus, 490 

Viburnum prunifoliorum, 490 

Vienna paste, 122 

Vinegars, 110, 6 

Vinum album, 341 

Vinum Colchici seminis, 527 

Vinum Portense, 342 

Vinum Rubrum, 342 

Vinum Xericum, 342 

Vioform, 610 

Volatile oils, 11 

Vomiting center of the Me- 
dulla, 280 

Vomiting, mechanism of, 141 

Vulneraries, 28 

W 

Wahoo, 152 

Warburg's tincture, 499 

Washed sulphur, 150 

Washing soda, 118 

Waters, 6 

Weakened heart action, 224, 
226 

Whiskey, 340 

White agaric, 425 

White corpuscles of the blood, 
function of, 187 

White mustard, 624 

White poppy, 305 

White precipitate (Ammo- 
niated Mercury) oint- 
ment, 508 



' White turpentine, 626 
White vaseline, 637 
White wash, 125 
White wax, 639 
White wines, 341 
Wild cherry, 270 
Wild cherry. Syrup of, 270 
Will power, mode of action^ 

279 
Wine of Antimony, 146 
Wine of Coca, 440 
Wine of Colchicum seed, 527 
Wine of Ipecac, 144 
Wines, 341, 6 
Wintergreen, 642, 522 
Wintergreen oil, 522, 642 
Wistar's cough lozenge, 317 
Witch hazel, 578 
Wolfsbane, 247 
Wood alcohol, 343 
Wood alcohol poisoning, 344 
Wood alcohol poisoning. 

Chronic, 345 
Wool fat, 637 
WooraU, 431 
Woorara, 431 



Xanthopsia, 181 
Xanthoxylum, 466 
Xeroform, 570, 611 



Yellow iodide of mercury, 508 

Yellow jasmine, 426 

Yellow Mercurous subsul- 

phate, 146 
Yellow oxide of mercury 

ointment, 508 
Yellow root, 484 
Yellow vision, 181 
Yellow wash, 509 
Yellow wax, 639 
Yerba santa, 644 
Young's rule for Dosage, 73 



Zinc, 565 

Zinc acetate, 566 

Zinc bromide, 567 

Zinc carbonate, precipitatedj 

566 
Zinc chloride, 566, 592, 633 
Zinc iodide, 567 
Zinc oxide, 566 
Zinc oxide ointment, 566 
Zinc permanganate, 608 
Zinc peroxide, 607 
Zinc poisoning, 566 . 

Zinc poisoning, chronic, 566 | 
Zinc stearate, 566 
Zinc stearate ointment, 566 
Zinc sulphate, 566, 592, 146 
Zincum, 565 
Zinc valerate, 567 



Zingiber, 138 



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